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P-12-539 • MASSACHUSETTS ETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK e� ) CITY ilLrar . MIL DATE INICHIMIDIN PERMIT Y! JOBSREADDRESS -i b—1-;ui n•• CarTilOWNER" • P OYVNL3tADDRESS: �^�rc�;�r�*-ate AOR OCCUPANCYTYpe OOMIER(Opl,0 �-�FAX� CLEARLY EDl1CAT}pHK � �BYTUL Nett❑ RENOVATION: MANS summit R111d , 1 FLOORS-6 Icaine ©© 4 5 IlEll MS Man 8 9 10 12 _ CROSSCONNOEwa ______10111111111.111111111111111111111111111___ _ DEDIf.ATEDSPEOALWASTE SYS =SYS _Ile_ al _=_ DEDCATED ATEDGREASESY ____��al IIIIIII aal n al DEDICATED GREASESYRSYS ___—�����_=__ _ ISIS DEDICATED WATER SYS __�����___ Me NM INN Mil IS 111.111 MN INN 1111111.111111 MI GRWg110FOUNTAN MUNI 1111111.1111111111 _______ FOOD WASTE GRINDER FLOOR ARAw UNIT �ol____a _S___ INTERCEPTOR INTERIOR �_�INNS _NM NS al_MIN__�_MIMI _ LAVATORY _�________ SHOWER STALL ��_�_�_�_____111111 In 1.1111.11 � TOILET /MOP3Nl( __ _______ T 111111111111111S Ila IMM la ASHNGMACHIfECONNECTION --__ _Man ____ ______ WATERHEATERAU.TYPES OJ_______ WATER PIPING r _____� MN le MN IIS mommm,m,..______11111.11annal NM Mlle MIN la EMI lainams 111111 Ihe+raacvrrent INSURANCE COVERAGE __����� 1 �is'nnpotty «b Mich mods thenmultemettaMGL Ch.142 YES tNO 0 ■ym,has checkedy ,please Wats the type ofcoverage byaassythsa appropriate below. ei box > . WBImINS Maar EOTHER TYPERIOEWTY 0 • • , ■ _OWNER'S �wAnnatlatsew,nuattrMna,�e the � , . 1• V E D Laws,end lad my signature on Ida permit ePPlalbr ro ' pir • SIGNATURE GF OWNER oR AGENT CHECK ONE ONLY OWNER IN Aapth 7.201 Q I herebyosrMy Ihetaldhadebts and hibmedon I have abated(rangy) .••• ,.••,,�•,�J•�••;"'- Knowledge dla VWal punting wak aid bsblaikas pwbmed Wederb psnrfl j d for Ut'pp&lonn tusand la � Meeedaaelle Stab Plumbi g Codeand Claptr 142 Mrs General Lara ba b wN1 M Pertinent PLUMBER we ti' f'fQarrr� UCBISE1® SIGNATURE COMPANY tame IfilliffnlEIMMISIMINFAIM A ■lace CITY: �7/j� a �'� STATE: F1'f11 LP. TEL:)k k:Ca-M! CHL 1 .n FAX — � Mi L9NALL: MASTER 0 JOURNEYMAN O CORPORATION Pig F33: PARTNERSHIP O/ ]LLC p1�