HomeMy WebLinkAboutBuilding Permit #410-2017 - 857 CHESTNUT STREET 10/18/2016 4&t Itt 11 V 1W
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APPLICATION FOR PLAN EXAMINATION ••�•� "
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Permit N0:� O � Date Received %O
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Date Issued:
IIMPOyRTANT: Applicant must
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LOCATION ( V �$ l)0-t NACA /4 OV f
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PROPERTY OWNER q-r Ne N10 4(EC
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MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building k One family
LJ Addition ❑ Two or more family ❑Industrial
X-Alteration No. of units:
❑Repair,replacement ❑Assessory Bldg ❑Commercial
❑Demolition
❑Moving relocation K-Other ❑ Others:
❑Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
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OWNER: Name: UP C(kb4veg- Phone:
Address: D�1 C s�-► - S4 �qP 6UP!'� emA yj
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CONTRACTOR Name: /26P �I N�iJO -�L Phone: � �d �f
Address: ./6-2 ),4Ef Ve!I Lei 'gel nlTqA40 0,?,Qy,V
Supervisor's Construction License: �bCI Exp. Date: 03 r p-8-,�bd
Home Improvement License: )36ys � Exp. Date: /a`iW 9U/7
ARCHITECT/ENGINEER Name: Phone:
Address: Reg.No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ 5-3,642, 18 x12.00=FEE:$
Check No.: A Receipt No.:
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