HomeMy WebLinkAboutApplication - 224 CARLTON LANE 6/28/2013 0ORTel
u...,..,� 0 KT V @ D I b W
BUILDING PERMIT � :` .�,, «� �L
TOWN OF NORTH AN DO 0
APPLICATION FOR PLAN EXAMINATION
n
Permit IUD: Date Received
p°RnrcD pp�+��c�
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATIONR
Print
° ' " m PROPERTY OWNER i(/" (1(
p J J Print qq `
t
MAP NO � �� � PARCEL � �>� -� BONING DISTRICT.4° �°`��i����� s o��ic District yes � r�p���
Machine Shop Village yes n6'-')
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building [. ,One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
N Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District
❑ Water/Sewer
p
d./ Vf� _,4.++ �1Y.1\�V't 4�._. .�P `, '�t.. '4--'1 �® "f:'.wC'.°®a•
'k �` + " �m p
CIA & r � �r a.
t
1 1 �dN" .
��„� �4� �_
WM a,. Identification IPleas e` Type or•Print Clearly)
OWNER: Narne: fk1� Phon �
Address: �� � ...( �` �. }�� Cf"9e''.�� ��w ���'" 4"��� �� ..��� {° �n�,, l
CONTRACTOR Name;
Address:
Su p ervisor s Construct ion License: � Exp. Date:
"
Home Improvement License: Exp. Date:
. pp
HNC
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: / t PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $��N�PERMIT:� � ���a
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have'acces to lie gzraranty fund
" ✓
Signature of Agent/Owner � �,� ° Signature of contractor ,✓ ' � �°°�
No
c"Z
12
.................
I'd
105
IRII
ri
"is
gg
WIN
oe)