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Date.
:1Mo TOWN OF NORTH ANDOVER
PERMIT FOR P UMBING
This certifies that .f.�... .�....N' (-...' ..... .....
has permission to perform .... H.Lr�.7 ......`i. ............ .
plumbing in the buildings of ..�%�. t !�s . ! .. � F'4 a . .... .
at. C. .......... North Andover, Mass.
Fee °� } . v.... Lic. No. v. ��.�.. ..... 1-..... .
PLUMBING INSP CTOR
Check # 10)- u
70)—B
0
i
14
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location // (/(/WI e,- Ca Owners Name
New ri
of
Renovation Replacement
FIXTURES
DatezuDAN
Permit # 'q
Amount , )I' -
Plans Submitted Yes ❑ No ❑
(Print or type) Check one: Certificate
Installing Company Name114(j 11Corp.
Address 6Q)11 Partner.
Business e ep one El
Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicatethtype of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature IOwner ❑ Agent E]
I hereby certify that all of the details and info ation 1 have submitte or entered) in ove applicatAne accurate to the
best of my knowledge and that all plumbing rk and installations perfo ed undo ermit u fo tion will be in
compliance with all pertinent provisions of the ate P1u bing C apter 142ral Laws.
y:
Title
City/Town
APPROVED (OFFICE USE ONLY
Type of Plumbing Lice se
rise Numver 7 Master Journeyman ❑