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HomeMy WebLinkAboutBuilding Permit #1805-2016 - 20 MILL ROAD 3/28/2016r 13UILUINU MIRIVIIT 3? 4•_:-f. _°::6 0� V �Ij �� � • TOWN OF NORTH ANDOVER so 1 'APPLICATION FOR PLAN EXAMINATION 5 � ,' - Permit N0: � -••� Date Received .0 Arso SACHus���y Date Issued: PORTANT: Applicant must complete all items on this page LOCATION 2-0 M L-L_RCA\> Print PROPERTY OWNER MSF-K.Uk 2?,21 L-1 C� I Print MAP NO: © ! PARCEL: ZONING DISTRICT: Historic District yesr(n Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential New Building Vbne family l�ddition Two or more family Industrial ✓Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer Obi S�Cnoly OE WA-LL F-52-110K-�-rc�t �rND DI>JU.�CT p n Identification Please Type or Print Clearly) Iv\ OWNER: Name: TkA- � u?li Phone: Nff> 656 Address: 20 MILL ROAD K)cW7m WDOvI�-Pl CONTRACTOR Name q-7 R Phone:. 4-2�) • IM Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: - Z� ��� t) 7-01-7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3�� FEE: $ 4 , ., Check No.: M-1 Receipt No.: 3c 1�00 NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Signature of Agent/Owne Signature of contractor ,t - a '