Jorge O. Elorza
Joseph M. Atchue,
Director/Building Official
Mayor
Department of Inspection and Standards
“Building Pride In Providence”
444 Westminster Street, 1st floor, Providence, R.I. 02903 Phone: (401) 680-5201 Fax: (401) 680-5482
Contractor Terminating Permit
To: Department of Inspection & Standards
Date: ___________________________________________
I, ___________________________________________________________________________________
Contractor’s name and registration number
Contractor Address ____________________________________________________________________
City _________________________________________________________________________________
State ______________________Zip _______________ contractor’s telephone #___________________
Location: ____________________________________________________________________________
Permit Number: _____________________________________
Date of Permit: ______________________________________
Reason for terminating:
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______________________________________ ____________________
Contractor’s Signature Date
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signature
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