HomeMy WebLinkAbout2019 Jan 24 - Sign Off Transmittal - Finish Room Above Garage „, TOWN OF YARMOUTH
s iitsitHEALTH DEPARTMENT
"td- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: /16 Di-ex Sly7ee,t, Ya r1,14 o UT(� Po ”
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Proposed Improvement: A K1 ist--) r &- n43°✓J. 9 ca,r-et ct7am.
Applicant: Pa Za c O 19S Tel. No.: -77y-3 r''?-(o S
Address: A 0, 6 Ox 3 >1/L/ Vii rviA O 1 C Pmt 1 4'1 F O— '73---- Date Filed: 0 y 2019
**Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: N GA/In-rot _)Z.i t
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Owner Address: 1 )-. D-6.6 k i e 5+, , (-Ivo 5 L H , Owner Tel. No.: ',03--'Ad 7- 6 E36.5-
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations;i.e., Requirements
For Septage Disposal and other Public Health Activities.
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Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed)
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: �:= r l..,"CG�i
441,
DATE: 1
PLEASE NOTE
COMMENTS/CONDITIONS:
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