HomeMy WebLinkAbout2022 Sign off Transmittal - Demo _ llt'+� k,� TOWN OF YARMOUTH H20ZHc o "
'�• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.
Building Site Location: 0 J)J f /Z
Proposed Improvement: _ 1L �-, T'�� "�
Applicant: cpcN co tug- Qv) 2Tel. No.: 6/`? 4-� 37q
Address: p`Z O ( 1.'l vl9l-(., AN JJ e.c-L1 vt/ mi.,. Date Filed:
**lfyou would like e-mail notification of sign off, please provide e-mail address: pit,/ E r j 66_
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Owner Name: fj-+i c e tU rt-Ci
Owner Address: -t o a f?WIZ I-I foe, Owner Tel. No.: a/7-,3c,7 •533-7
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: 09 1 DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
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