HomeMy WebLinkAbout2015 Dec 03 - Sign Off Transmittal Sheet, Plans - 3rd Floor Roof Deck and 3rd Floor Loft �o�'�R,,� TOWN OF YARMOUTH
� s,��1�� . HEALTH DEPARTMENT
��''��.```� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 2.c�,J w• � {�lC?✓�{ •
Proposed Improvement: R`� ,r- � R�- 6O✓' d�
Applicant: � r { Tel. No.: �c� �5 �22 13 6 2,.
Address: ���a,.�4 ��� /,�,,(�. L✓� � y1CG �9 Date Filed: /Z- �_ �)''
**Ifyou would like e-mail notiftcation ofsign o,fJ;pdease provide e-mail address:
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Owner Name: �/'4 v1 N5 �G ��
Owner Address: � Owner Tel.No.:
..................................................................................................:........::..............................................................................:......:....................................................................................................:..........................................................
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Deterrnines Compliance to State and Town Regulations;i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include: �
(1.) Site Plan showing existing buildings,water line location,
and septic system location;
(2.) Floar plan labeling ALL rooms within building
(all existing and proposed) —
Note:Floor plans nat required far decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE: �-- !
PLEASE NOTE
COMMENTS/CONDITIONS:
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