HomeMy WebLinkAboutBuilding Permit #521-15 - 21 FULLER MEADOW ROAD 12/3/2014h
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: G' Date Received
Date Issued:
IMPORTANT• Applicant must complete all items on this pat
LOCATION C) I
PROPERTY 0
MAP NO.:
PARCEL: IZ
TYPE AND USE OF BUILDING
TYPE OF IMPROVEMENT
❑ New Building
❑ Addition
❑ Alteration
❑ Repair, replacement
❑ Demolition
❑ Movin relocation
❑ Foundation onl
DESCRIPTION OF WORK TO BE
Print
ZONING DISTRICT:
HISTORIC DISTRICT
YES ❑
PROPOSED USE
Residential
Non- Residential
❑ One family
❑ Two or more family
❑ Industrial
No. of units:
❑ Assessory Bldg
❑Commercial
) f)Q( , Identific
OWNER: Name: a�
Address: D) V -i A\\ P r lu
CONTRACTOR N
❑ Other
Type or Print Clearly)
Address:
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❑ Others:
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Supervisor's Construction License: ^ ��"7' �'� Exp. Date:
Home Improvement License:_ Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT.- $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST B SED ON $125.00 PER S.F.
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Total Project Cost :$ x12.00=FEE:$
Check No.: Receipt No.: 1:2 3-2-Z
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