2018 Feb 20 - Sign Off Transmittal - Demo House - Fire Damaget
o=Yqk TOWN OF YARMOUTH
HEALTH DEPARTMENT
Er PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
Proposed Improvement:
Applicant: Tel. No. �
Address: r _i ?, ,; ,., � ; ;, s •` ; ' , Date Filed:
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**Ifyou would like e-mail notification ofsign off, please provide e-mail address:
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Owner Name: ct r o%y fi r
Owner Address: -'T u cEL
Owner Tel. No.:�--
AND/OR COA—�U°—i �'� BILL PYBAS
cvd�pvw Permit Coordinator
�rlpliance to St � /'tC7-c,( &-,_,Y,,(,_1"•
REVIEWED BY:
COMMENTS/CONDITIONS :
- - - - I Syc
3posal and oth Guaranteed Builders, Inc.
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MODULAR HOMES
it three (3) GARAGES
Telephone: 508-476-1500
14 West Street, Douglas MA 01516
an showing ADDITIONS
Cell: 508-284-1496
ptic system
Fax: 508-476-1392
plan labelh
'
isting and proposed) —
loor plans not required for decks, sheds, windows, roofing;
,ssary, Title 5 application signed by licensed installer
..........................................................................................................................................................
DATE: oZ a�a
PLEASE NOTE
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