17B-008 (13) (
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OCT 2 2 1982
THE COMMONWEALTH OF MASSACHUSETTS
APPLICATION FOR PERMIT TO DO PLUMBING
No.
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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BASEMENT
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2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
9TH FLOOR
10TH FLOOR
11TH FLOOR
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NAME AND ADDRESS OF BUILDING NAME CERTIFICATE NO.
CORPORATION_PARTNERSHIP
FIRM OR COMPANY A4.I
NEW OR RENOVATION
NAME OF MASTER OR JOURNEYMAN PLUMBER
NAME OF OWNER
ADDRESS OF OWNER
7 7 7 ADDRESS `V�a4le
PLANS SUBMITTED? YES TELEPHONE NUMBERS:
NO BUSINESS
ESTIMATED COST OF JOB ` ` RESIDENCE 73�O�Of
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.
$ignoture of Licensed Plumber
.` *9100
Designation and License Number of Plumber
FORM 1240 HOBBS 6 WARREN, INC., REVISED SEPL 1973