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EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth,MA 02664
(508)398-2231 Ext. 1261
CONSTRUCTION ADDRESS:
.,'Ll. _ - r\ _ - 5os_-at-.1W)
ON'\ER: _ �A I tom/ I'RI sI V UM) SS TEL.x t
P i
CONTRACTOR:����hh2 \I\II ISa ADDRESS TEL.t[MAIL: _ '--'0_"
5esidential -Commercial Est.Cost of Construction S
Homeowner is.Applicant:' liesZ No_
Home Improsement Contractor Lic.#
Construction Supers isor Lic.#
WORK TO BE PERFORMED
Tent Duration (Fire ire Retardant Certificate required) V. Stone
P
Siding: #of Squares
Replacement ssindows:# Replacement doors: #
Roofing: #of Squares Insulation Temporary Mobile Home
Temporary Construction Trailer Demolition-Interior onl `Demolition Raze Structure
Solar System_ ESS System Chimney_ Fence
*Please submit utility disconnect letters forelectric&gas-structures over 75 years old require historical rev less
. •The debris will he disposed of at _ 6.A I#A 4tfiSft 1 a �_
of Fac
I declare under penalties of penury that the state its herein contained are true and correct to the hes my knowledge and belief.I understand that any false answensl
will be just cause for denial or relocation o- license and for pro ution under M.(i L.Ch.26h.Section I.
Date _ ' I
Applicant's Signature N. - 44/6%
Date: "i/
Owners Signature(or attachmea
Date:
Approsrd li} -_
Building Official for designee)
Res n 24
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