HomeMy WebLinkAboutBuilding Permit #674-11 - Exception 4/6/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
°.ennit NO:�p
Date Received ! ��
Date Issued:
YN1F®RTANT: Applicant must complete all :items on this nage
LOCATION
Print
MAP NO: 99 PARCEL: `? JZONINGDISTRICT. Historic District yes no
Machine Shop Village yes no
T -%U 0 nU TDTTn"KT
Identification PIease pe or print Clearly)
OWNER: Name:
Address: —5�
CONTRACTOR Name:
Address:
Supervisor's Construction License:
EIome Improvement License:
Exp. Date:
Exp. Date:
Phone:
f
j ARCHITECT/ENGINEER Phone:
kddress: Reg. No.
FEE SCHEDULE: BULDING PERMIT, $12.00 PER $1000.00 OF THE' TOTAL ESTIMATED COST BASED ON $ 5.00 PFR S F.
'ofal Project Cosi: $ %� '�--' FEE: $.. . -
.j Teck No.:. may .. Receipt No.: p
'OTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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