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TOWN OF MONTVILLE
Department of Public Works
CApplication for Building Permit
Application & Permit No...... Date
Estimated C t
Fee .
Owner . AW GAL-'~! Address
Contractor Address
Architect Address
Location of Building
Zone No .
Additions & Alterations (including moving or demolition and sign erection) Ado 0-~
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New Buildi - ~
ng Type of Consfron
Size Type of Heat .
No. of Stories Fireplace
No. of Rooms Breezeway
No. of Baths Garage
Proposed Use
I hereby certify that the proposed construction will conform to the applicable zoning regulations of the
Town of Montville and the B is Building Code of the State of Connecticut.
Signed Approved
Date ..~?-r~... j. 7 Buildi Inspector ; •
Form No. BIMO 70-100-1
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