HomeMy WebLinkAboutBuilding Permit #672-2016 - 79 JOHNSON STREET 11/30/2015Permit NO: Gl -74
Date I
LOCA
aQ BU1LUINU t t:KMI I
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT:
must complete all items on this
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PROPERTY OWNER
Print
MAP NO: 0%PARCEI-06 DI ZONING DISTRICT: Historic [
Machine
TYPE OF IMPROVEMENT
PROPOSED USE
Resid ntial
Non- Residential
❑ New Building
N-6ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
19 -Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
0 Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
OWNER: Name:
Address
CONTRACTOR
Address: r
Identification Please Type or Print Clearly)
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I
Supervisor's Construction License: Exp. Date:
h9 3
Home Improvement License. Exp. Date:
ARCHITECT/ENGINE R U/ Phone: /)//I
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: $ / Q-YU FEE: $ ZC)
Check No.: ,1�,z► Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Signature of Agent/Owne 6 ignature of contractor
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