HomeMy WebLinkAboutBuilding Permit #355-2017 - 20 FULLER MEADOW ROAD 10/3/2016 0
TOWN OF NORTH ANDOVER 1 cE NORT1y 7�i �I� � L APPLICATION FOR PLAN EXAMINATION ? `41�e°ne eyo
Permit N0: 3�-s " °1L O � Date Received
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Date Issued: ill ' 3 ' ;La G
IMPORTANT: Applicant must complete all items on this page
LOCATION `;iU ;� arler Aeftlow /-�i c-V 12)1-16470�dei,iW
PROPERTY OWNER e11/f1STdAW--A Print<�,-700G/ -5
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MAP NO.: b '7 PARCEL: ZONING DISTRICT: S ,5
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential. Non-Residential
❑New Building ne family
❑Addition— S(�Q/LS ❑Two or more family Industrial
❑Alteration No. of units:
❑Repair,replacement ❑Assessory Bldg = Commercial
❑Demolition
I 1 Moving(relocation) I Other I Others:
❑Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
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Identification Please Type or Print Clearly)
CNR/S��0P�i� C'c0e51N�
OWNER: Name: Phone:
Address: �0 �l/�/r?l // °� 6
CONTRACTOR Name: �l'e4� /echl7blo /""' Phone: ?/0 I % —17ZV
Address:
�C�/!� Exp.
Supervisor's Construction License: j /�fl zo Date:
Home Improvement License: �S Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
**\XFEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BBA/SEED ON$125.00 PER S.F.
Total Project Cost :$ o��� x12.00=FEE:$_ JV
Check No.: 0 2� Receipt No.: .3�0
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