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THE COMMONWEALTH OF MASSACHUSETTS
------ Ci-T-Y------OF----PJ 0--4=--14-`}_ 7-`--�--------------
p APPLICATION FOR PERMIT TO DO PLUMBING
No. 19 e3
WORK MUST BE PERFORMED IN COMPLIANCE WITH ALL PROVISIONS OF THE MASSACHUSETTS STATE
PLUMBING CODE AND CHAPTER 142 OF THE GENERAL LAWS.
FIXTURES
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SUB-BASEMEN
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
9TH FLOOR
10TH FLOOR
11TH FLOOR
12TH FLOOR
13TH FLOOR
14TH FLOOR
15TH FLOOR
16TH FLOOR
17TH FLOOR
18TH FLOOR
19TH FLOOR
20TH FLOOR
NAME AND ADDRESS OF BUILDING NAME CERTIFICATE NO.
CORPORATION
PARTNERSHIP
FIRM OR COMPANY
NEW C R RENOVATION� E/y
�+ NAME OF MASTER OR JOURNEYMAN PLUMBER
NAME OF OWNER
ADDR SS OF OWNER ADDRESS
PLAN i SUBMITTED? YES TELEPHONE NUMBERS:
NO BUSINESS 9 rV"I',/Ile
ESTI TED COST OF JOB Y ' RESIDENCE
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate
to th 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 Plumbing Code and Chapter 142 of the General Laws.
Signature of Licensed Plumber
Designation and License Number of Plumber
FORM 1240 HOBBS & WARREN, INC., REVISED SEPT. 1973