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Home My WebLink AboutG-08-028MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date City, Town Permit #-gyp — Zo Building �%' / Owner' AT: Location e/ Name,sS �0e,6 Vs rfqe, �=�ed7-H Type of Occupancy:Gs New ❑ Renovation J9 Replacement 11 �P�..4u-mFiRl \\�\ (Print or Type) tt�•� Check One: Certificate Installing Company Name t • F - WINS LD(a ?L"910 +4A'Tl*E corp. pµ-284 6193 Address S RE WZ1>01 j [(P -C(-9- [] Partnership S • vizim 0 UT 1+ M OZ -64 y ❑ Firm/Company Business Telephonc($08)39.4-777 8 Name of Licensed Plumber or Gasfitter I . F • W IAJS L.a w IL - f hereby certify that all of the details and Information f have submitted (or entered) In above application are true and accurate to the est of my knowledge and that all plumbing work and Installations performed under Permit lamed for this application will be In comptlanoe with all eminent provisions or the Musachusetta State Gas Code and Chapter 142 of the Genual 1Lwa. By TYPE LICENSE: • Plumber Title Gasfitter Signature of Licensed City/Town: NMaster Plumber or Gsfitter APPROVED (OFFICE USE ONLY) Journeyman License Numm erG C -01W �iill IIIIIIIII�IIN .................. WEiiiiiiiiiiiiiiiiiiiiiiiil (Print or Type) tt�•� Check One: Certificate Installing Company Name t • F - WINS LD(a ?L"910 +4A'Tl*E corp. pµ-284 6193 Address S RE WZ1>01 j [(P -C(-9- [] Partnership S • vizim 0 UT 1+ M OZ -64 y ❑ Firm/Company Business Telephonc($08)39.4-777 8 Name of Licensed Plumber or Gasfitter I . F • W IAJS L.a w IL - f hereby certify that all of the details and Information f have submitted (or entered) In above application are true and accurate to the est of my knowledge and that all plumbing work and Installations performed under Permit lamed for this application will be In comptlanoe with all eminent provisions or the Musachusetta State Gas Code and Chapter 142 of the Genual 1Lwa. By TYPE LICENSE: • Plumber Title Gasfitter Signature of Licensed City/Town: NMaster Plumber or Gsfitter APPROVED (OFFICE USE ONLY) Journeyman License Numm erG C -01W