HomeMy WebLinkAbout2023 Sign Off Transmittal - Interior Remodel TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 21 '00-6 a_-, W Q S i - 44)
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Proposed Improvement: e l ( l c I I V l
cry' (�000.m .G k,
Applicant: Gas CUc\SA (2)VA l01) \�C f' .-{7{r„ Tel. No.:5� L+-0
Address: e� ( (�QA P ?� a 0 Date Filed:
**Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: \ 3U. ! J D
Owner Address: 21 U6004 b( ( AN)Q
Owner Tel. No.:7'1q-Zo 8
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:
--- -- - (l.) Site Plan showing existing buildings, water line location,
and septic system location;
MAR 13 2023 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALT H DEPT. 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/. �� • DATE: � .;-' '
A- t_r
/� PLEASE NOTE
COMMENTS/COIQDITIONS:
i i/2_ :;i>
BEDROOM
o EXISTING
ICLOSET
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LIVING ROOM
EXISTING
BEDROOM
EXISTING
2668
a HALL
' �EXIST�NG
BATH
EXISTING
CLOSET
2868
LISTING
FLOOR PLAN
SCALE: 114" - I'=0"
AREA: 864 S.F.
REF
BEDROOM
EXISTING
KITCHEN
EXISTING
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MAR 13 2023 N
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HEALTH DEPT.
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MAR 1.3 2023
HEALTH DEPT.
FLOOR
SCALE: 1/4" - V-0"
AREA: 864 S.F.
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