HomeMy WebLinkAboutBuilding Permit # 4/23/2015 t\ORTH
BUILDING PERMIT ®FR�LED0 Ira
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received �Ss ATEDUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 1'r'
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PROPERTY OWNER' r L ! /
Print 100 Year Structure yes no
MAP :�PARCE ZONING DISTRICT: Historic District ye no
Machine Shop Village ye I 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 r
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DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: 6 Phone: q7
Address:
Contractor Name: Ur/16eA s 41, Phone:
Email:
Address: "I
Supervisor's Construction License: ; ° Exp. Date: '/
Home Improvement License: 12c) 7 S Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ �c�—T ' FEE: $ .
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Check No.: � � R o.: V" nP
NOTE: Persons contracting with unregistered contracof h ve ac s to the guaranty fund
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