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OKH Application #:
Owner:
Contact Phone #:
TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451
Telephone (508) 398-2231 Ext. 1292 Fax (508) 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
Site Inspection
Occupancy Permit Other (Specify)
-A-C?6E -Al Property Address: _ � ��rnov 11�
Contractor:
Contact Phone M — lvo9
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Inspection by: !t i 0VA7'� 6;t C=c-.✓ r✓lq � " 4 Date: 7 f //2,'/-,,-Time: %l: 3p am to
✓ Pass Pass Pending Receipt of As -Built Plans As -Built Plans Received:
Fail Remedy: New CIA Minor Change Lettep
112016