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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:
OWNER: Sq•r ,`DS--C sc'`r, '•2J•o a\7 ,5 ,�rachr xb2.SSo-SoSCs
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CONTRACTOR: \� O:JC.JC�-i 5l2 2.\. 2, �I0(Xt�l..:� ooS� �3`{-�i���
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_Residential Commercial Est.Cost of Construction S SCZ
Homeowner is Applicant? Yes No
Home Improvement Contractor Lic.# Construction Su pen isor Lic.# C.J'"O>A`kTrk
WORK TO BE PERFORMED
Tent Duration (Fire Retardant Certificate required) Wood Stove
Siding: #of Squares Replacement windows:# Replacement doors: #
Roofing: #of Squares Insulation / Temporary Mobile Home
Temporary Construction Trailer Demolition-Interior only V/ 'Demolition Raze Structure
Solar System ESS System Chimney Fence
*Please submit utility disconnect letters for electric&gas-structures over 75 years old require historical res less
'The debris will hedisposedofat. )Incrp,5:1_. 4O-s:'e bab c .<- ) "Ir r r` M
Location of Facility
I declare under penalties of perju ha the statements herein contained are true and correct to the hest of my knowledge and belief. I understand that any false answensl
will be just cause for denial es°caln of my license and for prosecution under h1.Ii L Ch.26a•Section I.
Applicant's Signature - - --
On ners Signature sits meat) Date:
-\ppros ed less Date,
Building Official for designee) --�
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