HomeMy WebLinkAbout1675 MAIN ST (19) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WIlVDSOR PERMIT#
Application is hereby: ��o?7P
BUILDING DEPARTMENT
APPR 1540 SULLIVAN AVENUE
Bldg.Permit#
l3 jg_— 644-2511 ext. 230 5-� �-
at Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
16115 01D
$0-$1,000=$15.00 Street No. Stt�eet Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �i ,(�l ifff W<
APPLICANT ADDRESS a
Ct M0
APPLICANT PHONE#
W N S OWNER . ::I- ��OlLrciy
O
g q� OWNER ADDRESS
:M OWNER PHONE j Q
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ O. 6t
TYPE OF JOB:
�SOR-C�� New ation
teration/Addition/Repair
Revised 4/01//2002