Loading...
HomeMy WebLinkAboutPlumbing Permit a"' of � G2 . © E D V E ' LICATION FOR PERMIT TO DO PLUMBING ►- °e r V TOWN OF YARMOUTH N O V 0 W2 (OFFICE USE ONLY) fix; HEALTH IST, =- Fee: $ c25-et' �~ f ��, `) Uz-7:-7 PERMIT NO. — p?Ja 0 4 2002 a , Nov I I �,` Date/10a 20 .'C � I A" Build n: •A; ' Owner's /(� /( 1 ° ` ,irAT: Location -om.- -v- 4/ 1 .ii /C'L P> Name Type V ff,Occupancy .4 ' � i o, ` New Renovation 0 Replacements X . p Plans Submitted Yes 0 No z 4 I ,, F- fn J U z Z LIJ us Z �, 4 cc F cu cc _ �, O z z ch m .� W J to 4 z � d � - u) o. C) z E m ¢ CI) cc } Q H Cl)NZ G Q OQG d. OQ[ 0 Z m u) coN Z J a ~ 9 F 0 = a ' it IQ . 3 .z a.0 O N Z Z Q u) LI"0 0 ILIM '' F. � w H O V � _ a Q x c cn a a o a o ° Q cc cc cc Q o Q t- Y J m to G C J s m i- mu- o m G Q 3_OC-m0 SUB-BSMT. BASEMENT _ 1ST FLOOR _ _ 2ND FLOOR 3RD FLOOR _ ,(PRINT OR TYPE) _/ ' Check One: Installing Company Name 6- '� Ye rl ❑ Corp. Address /P` Ptt./(),41/1/1A/), '/ 0 PPt1milip " 'G x(10Firm/ ompany Business Telephone fe.23 c0 f'" 2 AP:,4/ Name of Licensed Plumber �L�� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent.Check One: YesNo ❑ If you have checked YES, please indicate the type of coverage by king the appropriate box. A liabilityinsurance policy Otherr.� 1 !� Y type of indemnity ❑ � � I i! OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voer.s o uired by Chapter 142 b( the Mass. General Laws, and that my signature on this permit application waives this requirement. NOV 0 5 2002 i Ii II Check on Owner 0 gent 0 Signature of Owner or Owners Agent 4 / = / I hereby certify that all of the details and information I have submitted ` •':ature of Licensed (or entered) in above application are true and accurate to the best of Plumber my knowledge and that all plumbing work and installations performed ge9f49 under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and License Nur}tber Chapter 142 of the General Laws. Type: Maste Journeyman 0