HomeMy WebLinkAbout2020 Jan 09 - Sign Off Transmittal, Floor Plans - Remove 2nd Flr Kitchen; 2nd Flr to Bldg Code . 0t
NTOWN OF YARMOUTH
,r HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 4 . . I , I (Ric -/ U /40‘..)i ;,r
Proposed Improvement: r5r, n� Sc c n n c( ! 3 of. ( (1,/l„7.' C .7 c ie :
Rs wiovtd k t- c�+1rL a.'"J ree.
Applicant: 1 ec L)/l
i o. 8rA t /el. No.:
Address: 2 <:5 _(1,1 c I t S 1, c.,..,, le;. c, i)c • nn i Mil , Date Filed: S i q
**Ifyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name: L e 6fine do AJc , C116 I v
Owner Address: Pine Wood Rti. VC,r,;ii iUi Owner Tel. No.:5t 3-5? 3'1-iiit z/
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: DATE: / /?/-A,0c)1
PLEASE NOTE
COMMENTS/CONDITIONS: 16v5-e. (Ai c`( ;�-e- 17/ /3-G C1 V'U Govt. f O& i iC ( rco(
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