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Date �//v .....
o
TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
'�S CMUS
This certifies that v
............................
has permission to perform ... �L� P. :- - �� -'/' " ':'
.....................
plumbing in the buildings of .......................
at "� .? � . L"t . C' North Andover, Mass.
- ';, .13 � e . . . * I 1 1 4.
FeeY. � ..... Lic. No. . ...... L) _-,, -�R .......
LUMBING INSPE T
Check # I 'i )—(
7459
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSET`TS
Building Location 2--?/ 6r&Vf4-ajC1',r- OwnersName P
Now 1:1 Renovation a-" Replacement []
FIXTURES
e- r.'r �, � /
Date 4.�()
Permit
Amount
Plans Submitted yes No
(Print or type) —1� Check one: Certificate
Installing Company Name A c) ,,,T c 0,,
Address . L If 0 Corp.
ElPartner,
9 -3
Business Telephone -3 ?
Name of Licensed Plumber -T-./,? - f 1,7 -� I Lae- r,-, 4 -Z -�
Insurance Cover -age: Indicate the type of insurance coverage by checking the appropriate bo2c
Liability insurance policy Q-- Other type of indemnity 11
Bond 11
Insurance W L the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner El Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts S 9 Co0Qd qfip� .142 ofthe General Laws.
By: 2!=<' C�=�
Signature oi L'Icensea r1umbel
Title Type offlumbing License
City/Town 'LP L6 (3
APPROVED wFia usE oNLY License N umoer Master Journeyman Ej--