Loading...
HomeMy WebLinkAbout2011 May 10 - Sign Off Transmittal FormL L oYrYq TOWN OF YARMOUTH k c HEALTH DEPARTMENT 46%`l x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: �},, Building Site Location: ' r I Pr 1 /V 6y Proposed Improvement: & X l STI N G �L i' 2 © � �/ S • M .? -r-P_L t p c✓ E /l C Jfi � b sal L� --Syr't�g- Kq�t�l.r9bR� IM�Y'�flG�2� S�RK�2I�o3P�'i�tL� LCCr Applicant: (� Q � R (i5-D M ►1, L Al P1r- L-! Tel. No.: Address: 313 M pfl"j I Rio -u Date Filed: S 1 It **Ifyou would like e-mail notification ofsign off, please provide e-mail address: Owner Name: 64r4,jA_q KAr4 SA&,�-, MA,YA6EA LAG Owner Address 105- 1 1 n (gi o q 7yLCF7_ Owner Tel. No.: ................................................................ ..g���.!�.6.. v�..)....�.�........�......�..o...3................................................................................................................:........................................................ HEALTH DEPARTMENT: RESIDENTIAL AND/OR COMMERCIAL BUILDING Determines Compliance to State and Town Regulations; i.e., Requirements Isnosal and other Public Health Activities. TEVNANITEVNAN CHARLES R. TEVNAN � 17- S 17- IWO Sears Crescent Building �tevnan@tevnan.com 100 City Hall Plaza 'H 617.423.4100 Fifth Floor :AX 617.423.2596 www.tevnan.com Boston, MA 02108 with REVIEWED BY: 0 ,e (3) copies of plans, to include: [)wing existing buildings, water line location, stem location; abeling ALL rooms within building and proposed) - ans not required for decks, sheds, windows, roofing; , Title 5 application signed by'licensed installer PLEASE NOTE COMMENTS/CONDITIONS M " i -C (_� 3-C V w c �4,v t DATE: / / G l l / ?- � D z-n7 -