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Date.�!�'•�•�
TOWNS NORTH ANDOVER
p PERMIT FOR PLUMBING
This certifies that ..13 .W... u A/./ ............................
has permission to perform ... .. ...................... .
plumbing in the buildings of . !%- .�. �` .�. ................ .
at .... c.. 67. <11: 6..S y:... l �� .' .......... , North Andover, Mass.
Fee. 3.1 " .. Lic. No. ? .t. y.5. ...... d-, . �(- �'I-.�-!3.......
:�
PLUMBING INSPECTOR
Check # ( .) )
6722
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
I
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
V I
of
Date j S _'b e I 10 5
Permit # 4 7 2 -
Amount
Amount 3 L
New 0 Renovation Replacement Im Plans Submitted Yes No
(Print or type) �� r� Check one: Certifiate)
Installing Company Name �/�J U l V ❑ Corp. �
Add ss j�% t
" "-7777
Partner.
►M
usmess Telephone Firm/Co. 1
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurAhce coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the lbove
three insurance
Signature IOwner M Agent rl
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 installati�oed r PermitIssued for this application will be in
compliance with all pertinent provisions of the Massachuse s e ar M—f41-o€-Ehe General Laws.
By:
APPROVED (OFFICE USE ONLY
of PlumbinR License
MasterPf 1 Journeyman ❑
1'
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(Print or type) �� r� Check one: Certifiate)
Installing Company Name �/�J U l V ❑ Corp. �
Add ss j�% t
" "-7777
Partner.
►M
usmess Telephone Firm/Co. 1
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurAhce coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the lbove
three insurance
Signature IOwner M Agent rl
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 installati�oed r PermitIssued for this application will be in
compliance with all pertinent provisions of the Massachuse s e ar M—f41-o€-Ehe General Laws.
By:
APPROVED (OFFICE USE ONLY
of PlumbinR License
MasterPf 1 Journeyman ❑