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HomeMy WebLinkAboutMiscellaneous - Exception (424)BUILDING PERMIT - - TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �• moo# m~ Permit No#: Date Received . Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print - 100 Year Structure yes no MAP 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 7S- tie ®i Well firFI'.o©`dplain z ®Wetlands ; $ < ®'Watershed :®r$-ric esp iw er/�Selwerk DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: AddrPSS- Contractor Name: Phone: Email: - Address: IN Supervisor's Construction License: Exp. Date: Home Improvement License: ARCHITECT/ENGINEER . Date: Phone: Address: Reg. No. • - r 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 cont„Nacting with unregistered contractors do not have access to the gJ!gYanPy fund