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HomeMy WebLinkAboutBuilding Permit #Exception - 5-Johnson Street 5/1/2018 BUILDING PERMITof Noer" qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received p�RATEG PPP`•(� �SSACHU`��� Date Issued: IMPORTANT: Applicant must complete all items on this page LOC AT]ON` < 3 Priv PROPERTY©WNER U S c Print MAF NO; PARCEL ZOIV'ING D)STRIT Historic D�str%c#, es >no _ _r 4 1' achlne Shop Village :yes: `. no ; . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commerci Repair, replacement Assessory Bldg Demolition Other Septic Well ;Floodplain . 1Netlands Watershed Dis#rict Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: ——Identification Please Type or Print Clearly) OWNER: Name: J •y C�__`,_0 v14 Phone:93 R- 9911 , Address: `-1 C•-S.st.� e C, er C.O;NTRACTOR 'Nphone. Address:` Supervisor's Construcfiori ticense: Exp: Date: Home lmroverr�ent License, Exp. ate:� 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: $ : ' FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signatureµof Agent/Owner a Signature of contractor X'