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MASSACHUSETTS U141FO ✓ M APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
'Z-
NoAthampton Mass . Date 19
City, Town Permit If
Building Owner ' s
AT: Location 79 Au.6tin CiActe Name m.%. M)L,5 Wotb He,%zoq
NoAthampton, Ma Type of occupancy:
New ❑ Renovation 1:1 Replacement ❑
Plans
FIXTURES Submitted: Yes Lrl No
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SUB-"BSMT. L
BASEMENT
1ST FLOOR
2ND FLOOR I I f
3RD FLOOR
4TH FLOOR
STHFLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
(Print or Type)
Installing Company Name- Anget M. Ltavona cl:'Ieck One: Certificate
EJ- Corp.
Address 53 Nnth BAidoe St.
EJ Partnership
Hotuoke. Ma 01040 E-J Firm/Company
W elephone Name of Licensed Plumber
Anget M. Ltavona
I hereby certify that all or the details and information I have submitted(or entered)in above application are true and accurate to the best of lily
knowledge and that all plumbing work and installations performed wider Permit issued for this application will be in compliance with 211 pertinent pro-
visions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By
Title SiXc�lture of Licensed Plumber
Type of Plumbing License
City/Town: 9840
MV
APPROVED (OFFICE USE ONLY) License Number Lai Master ❑ journeyman
?933/�
Date ...... ..................................................................19
PISinter ........................................................................
Owner ......-) ...................................................
Address ...................... .................... .............................
......................................................................................