HomeMy WebLinkAboutPlumbing Permit and NotesAPPLICATION FOR PERMIT TO DO PLUMBING
TOWN OF YARMOUTH
►° � (OFFICE USE ONLY) .
MAC ACHEESE B\/ --��
"'o __ Flee: $ R
R q
�` o1 PERMIT NO.
MAY ® 0 2008
jDate / 20 U
Building. - --� Owner's lr( i
AT: Location 77 c Name
Type of Occupancy
New ❑ Renovation Replacement ❑
Plans Submitted Yes ❑ No H**' \r4 C"�-
(PRINT OR TYPE)
Installing Company Name
Address
Business Telephone X
e:
n 0„+^ership-
3-3-ag
Company
INSURANCE COVERAGE: Ihave a c
dent. Check One
If you have checked YES, please indicate
A liai �vl. ;tist� Ll�l C��i `ltr}' ❑
No O
Bond ❑
OWNER'S INSURANCE WAIVER: I am, / �`� verage required by Chapter 142 of
the Mass. General Laws, and that my sit �/� � 1 Cam' % � ent.
er ❑ A9 ent ❑
Signature of Owner or Om
I hereby certify that all of the details
(or entered) in above application are
«�'l�' l� Signatur f Licensed
my knowledge and that all plumbing �"a ?!�j' f17 fCvy/ �! mbe.r
w
under Permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing. Code and License Number
Chapter 142 of the General Laws. .f,/
Type: Master I� Journeyman ❑