HomeMy WebLinkAboutBuilding Permit # 12/28/2005 (2) MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO ISO PLU O
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date 4 �
Building Location Owners Name C Permit# ,)-Z-
Amount
Type of Occupancy e i nJ
New Renovation Replacement Plans Submitted YesED' No El
FIXTURES
r� co
0.
Cr z
rz
.510 FLOM
BSS+f�`VJ_pNi'
) -
7HINDOCR
SITI:
(Printor type) Check one: Certificate
Installing Company Name As L�- p �� Corp.
Address i [� �J ---- ------ Partner.
Business Te ep`one 9 7 ,a 5-% "G, FurnlCo.
Name of Licensed Plumber: Zak a
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity rl BondLi
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 Owner Agent
Li
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 State P bing Code and Chapter 142 of the General Laws..By: Signafure 61 Ei-c-e-n-seffT1-u-m-Uer
Type of Plumbing License
Title 1/0.3
City/Town License 1 um er Master Journeyman
APPROVED(OFFICE USE ONLY