HomeMy WebLinkAbout2019 Nov 14 - Sign Off Transmittal, Floor Plans - Smoke Damage Reqpairs r-A4,Q ` TOWN OF YARMOUTH
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` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 7 , 2 2i .6fri ) Ss/
Proposed Improvement: ,�. i 1/6 . 2 i7 3/'f
Applicant: ...27-_,,07)1/ ( t) j17.5.IN Tel. No.:: j --CAJog ,,
Address: ;),/j) ,7' �,r ;;,yid _ /"'Y 4 0) \ Date Filed: //,,, ,4`"
**Ifyou would like e-mail notification of sign off,please provide e-mail address: l 0:7--&t". 4 7/ ,41 , r^'/vi
Owner Name: ? a/M/. /-_--76/..:-,-z,40 ,
Owner Address: _ / ( i{%r :,::// Owner Tel. No.: Ar�-. 35--
RESIDENTIAL
'jRESIDENTIAL 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 Iocation,
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 S application signed by licensed installer
with fee.
REVIEWED BY: "(77),,,-1.,„
DATE: />////. /./
PLEASE NOTE
COMMENTS/CONDITIONS:' ,
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