HomeMy WebLinkAboutBuilding Permit #353-2017 - 140 MILL ROAD 10/3/2016 �10RTH
I�IBUILDING PERMIT
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAM
IN TON 4
Permit NO: Date Received '� •
date Issued: d 3 ��
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IMPORTANT:Applicant must complete all items on this page
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PRCJPERTY OWNER : C l 9� /�'1 4 j
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MAP NOz/- §PARCEL-, W2' ZONING DISTRI( Historic District yes'
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TYPE OF IMPROVEMENT PROPOSED USE
Resicjential Non- Residential.
❑ New Building One family
❑Addition ❑Two or more family ❑ Industrial
❑ teration No. of units: ❑ Commercial
R"Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
' ❑ odplan ❑Wetld0Nat6rshed District
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Identification Please Type or Print Clearly)
OWNER: Name: Phone: cl 7 - y 7 .
Address: �U �� �Jd L/?-r
GONTRP��1`Of Name � hgne
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Supervisor's Construction License: Exp, Date:
Horne Improvement License Ir11 Exp Date (
• -Y. Y' �` - _ � �� +`�� :n 1 � Vii:.
ARCHITECT/ENGINEER 11'-111l Phone:
Address: Reg. No.
FEE SCHEDULE:BULDINC PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 4 71 •7 - o FEE: $ - q 6-6 "I� . �b
OCheck No.: "8' ! Receipt No.: 30TY—T-
NOTE: Persons contracting with unre is red contractors do not have access to the guaranty fund
grtaturerof AgentlOwngr Signature-of contracto
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