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TOWN OF MONTV I LLE
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Permit No. Date /
Estimated Cos 6 Fee- Q 10
Owner dyes le.
Contrac r Address Tel e.
Location of B u i 1 d i n (I Z 2 ~ 9, Z
.2 a Additions & Alterations (Including moving, demolition, sign erection)
New Building - Type of Construction
Size Type of Heat Fireplaces
No. of Stories No. Rooms Bree 'ay
No. Baths Garage U e
I hereby certify that the proposed construction will conform t the applicable zoning reg-
ulations of the Tow of Montville and the Basic Building Cod of the State of Connecticut ,
and that all statements herein contained are true and corre
r
Signe Approved
Date '?-//-717 Bui 1 di ,Inspector
- v
r--' J ~ 1/ e 10 7/Z0,1 XILC /A20 4 off'
17 Z?
Rough Wiring
Electric Service
Rough Heating
Fireplaces
Other Misc.
Final Inspection for C.O.
Approved Rejected Signed