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APPLIGATION FOR PERMIT
01115
Gity or Town Yarmouth
Date:t2 / o1/ 2021
permit Number: 102909
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 28 ACORN HILL DRIVE /South Yarmouth, MA 02664
For permission to: Unvented Gas Heater lnstallation 527CMR'1.'12.8.6
Name of Competent Operator: LUND/SCIOLETTI PLUMBING & HEATING Cert. No
Date lssued-Rejected L2 / Ot / 2021 By
Fee: SsO.00 $ paid
(Signature of applicant)
Due
139
28AC01
Date of Expiration: