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SUB-BASEMENT
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
TH FLOOR
TH FLOOR
9TH FLOOR
10TH FLOOR
11TH FLOOR
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Nqp� IAIND ADDRE S OF Bu ILOING NAME CERTIFICATE NO.
CORPORATION_
tZ t P,tt, Si G- C t 1 PARTNERSHIP
L FIRM OR COMPANY
NEW OR RENOVATION A C)e
NAME OF MASTER OR JOURNEYMAN PLUMBER
NAME OF OWNER
ADDRESS OF OWNER ADDRESS
PLANS SUBMITTED? YES TELEPHONE NUMBERS:
NO BUSINESS
ESTIMATED COST OF JOB RESIDENCE
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 Plumbing Code and Chapter 142 of the General Laws.
Signature of Licensed Plumber
Designation and License Number of Plumber
P OP
2478/366
Oct -
Date ......................................................................19......84......
Pluin,)er Charles .".azdski Jr.
......................................................................
..
Ch-rtes Plumbing
l—
Owner ........j.......o....,....I......Poud...........rier....................................
Address .... .............
-Repl&ceiaert
.......................................................................................................