HomeMy WebLinkAboutBuilding Permit #612-13 - 793 FOREST STREET 3/20/2013Permit NO:
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this Mee I
LOCATION Yq 3 So s+s+ 1 . Alar b Q tidy y� Ad q
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PROPERTY OWNER kICC f 11oti4 (0I ctti foNio
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MAP NO.: / U 5 4_ PARCEL:
TYPE AND USE OF BUILDING
ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
t 11194
60/gA2YL01Vi
Residential
Non- Residential
❑ New Building
❑ Addition
14 Alteration
❑ One family
❑ Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving relocation
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
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Please Type or Print Clearly)
OWNER: Name:
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t 11194
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Address: Z tS
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k s i A16114,
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dU ✓E/' A44
CONTRACTOR Name: 6 C4y S N G D ?,PAJo VAT Uel/ S Phone • & ) 2 `f 7 -2 -OK �
Address:
Supervisor's Construction License: a 3 � Exp. Date: 7 ;? -/I/
Home Improvement License: 169971 Exp. Date: q -)7-r3
ARCHITECUENGINEER Name: Phone:
Address: Reg. N
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST SED N $125.00 PER S.F.
Total Project Cost :$ ,,� l� 5 �.a x12.00=FEE:$
Check No.: `0 Receipt No.:
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