HomeMy WebLinkAboutBuilding Permit #764-2017 - 60 WILLOW STREET 5/1/2018 /m--4 �V_ p10RTh '1
BUILDING PERMIT �?b•`"tom
TOWN OF NORTH ANDOVER
APPLICATION EOR PLAN EXAMINATION
Permit NO: L 0 l 7 Date Received ��1" 101-7 � 4 . + �
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Date Issued:
IMPORTANT:Applicant must complete all items on this page �9SSACHUS
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LOCATION 00
PROPERTY OWNER� ohm cit, iA Pn =46Y 1 c�ls, GLC
Print
MAP NO: PARCEL:_ZONING DISTRICT: Historic District yes no
Machine 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: ❑ Commercial
❑ Repair, replacement ❑ Assessory Bldg ❑ Others:
Demolition ❑ Other
❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District
❑ Water/Sewer
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Identificati. n Please Type or Print Clearl
OWNER: Name: Q(=� 1 GucJ Hj,�,)S Phone:
Address: fl Dw -Ce4
CONTRACTOR Name: Phone:
Address: J 0 ? S� �t-?/- !, ,
Supervisor's Construction License: y5 Exp. Date: l �l
Home Improvement License: Exp. Date:
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.
Total Project Cost: $ FEE: $ �0
Check No.: Receipt No.: 53 S I
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner � `__ Signature of contractor
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