HomeMy WebLinkAboutLP install application & Permit - LP Gas Tank - 3/16/2017 '� � ��% ��/�/Of,(/9Z� I!e' ( t'�J"1 /`}✓1 C/`�i�C.i."� - v`-��'r, 1 ..
F� Application for Standard Permit
FP-oo e+ Return completed application to:
(Rev.04/12)
Permit Number: DIG SAFE NUMBER
City or Town: r 01! /
Date:
Start Date:
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In accordance with the provisions of M.G.L.Chapter 148,as provided in Section application is hereby made
/^ (`Full Name of Person,Finn or Corporation) (Phone Number)
of �� ct.5 e ry Ave C�t,�
(Address:Street or P.O.Box,City or Town,Zip Code)
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for permission to(state clearly purpose for which permit is requested) 2 ` ! }U t (
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Name of Competent Operator(if applicable) ,ert.No.
Date.Issued-rQjeeted-.--,�7^,4 /7 By
(Signature of Applican)
Date of expiration Fee Amount Paid$ v
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FP-006
(Rev.04/12)
PERMIT
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City or Town:
DIG SAFE NUMBER
Date:
Start Date:
Permit Number(if applicable):
In accordant with the provisions of M.G.L.Chapter 148,as provided in this permit is granted
to r-W� <5�:(�C e� (kj o(^
/ (Full ame of Person,Firm or Corporation)
for Z�l Vj�t (�
Restrictions:
at )C1
(Street and#or Describe Location for Adequate Identification)
free Paid$ � D is permit will on
Signature of Official Granting Permit: e
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This permit must be conspicuously posted upon the premises