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HomeMy WebLinkAboutBuilding Permit # 6/12/2015 i, 6 NOWTa�b BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit 140:-/ `'�� /`� Date Received nc u Date Issued, IMPORTANT:A2plicant must complete all items on this page LOCATION i �'2 -Ju��.'I�� �''r'�7�°, f PROPERTY OWNER r -'>r�1GYf ✓lIC'�"rC�' print MAP NO PARCEL'_,;,__ZONING DISTRICT-Historic District yes-. no Machine Shop,Village yes. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building One family L Addition I Two or more family ❑Industrial Iteration No.of units: ''Commercial ❑Repair,replacement L Assessory Bldg a Others: L Demolition L Other n Septic ❑Well C Flo6dplain D'Wetlands ❑Watershed District 0 Water/S2wer CJI ) �1Cll(K4 -SfX C qJC�`/L-�Y�)�L� Identificatiio�o77n Please Type or Print Clearly) 77 OWNER: Name: I �Cl'�. ���� PhonefT (�"�7 �1"t��� �� Address. ,, .��� '1%e ) CONTRACTOR Name: Pbon Address. Supervisors Construction License: Exp Date; 0-f 5 „r Home Improvement License: Exp Date. ARCHITECT/ENGINEE 1LJ�,I�k'7( 5 ��1�7(�C (��Phone.--1­6 Address: Irr-I 51-21,Z�- tLX AAS' ��' Reg No._ FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BB $1 too PER S.F. Total Project Cost:$ %� Or -�20 FEE:$ _ Check No.: Recei}ot.,No' a NOTE: Persons con acting with t tnreges Bred contractors do not have access to the or 1,f Signature of Agent/Owner2 Signature ofcontractor ,_.�....