HomeMy WebLinkAbout2019 May 30 - Sign Off Transmittal, Floor Plans - Repairs due to Fire ofk, TOWN OF YARMOUTH
x't4 ° HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 0
Proposed Improvement: 1� lig. T ' t. ,
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Applicant: (./014 U 1ems -effai€fhiik 4 'I'-S ?V (/?2 UY
Tel. No.: 7
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Address: ,„7 2 ; `I,t'f. '((//6 / ,4/ Act/1 if.5 /b// Date Filed: ~3(,) PI `1'�1
**lfyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: , a r 1/1/ 4.)v
'Owner Address: 3 r ;r o',"siAxa
-bwner Tel. No.: 7 7 v �� _,�
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.
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: /0--7 `fJ DATE: 5d
PLEASE NOTE
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