HomeMy WebLinkAboutPermit Vent-Free Heater 2019 - Permits - 2/6/2019 Application for Stalndard Permit
(Rev.1,1,2016) Return completed application to: 42
Permit Number.
=SAFECity or Town Date:
In accordance with the provislon's of M,G.L.Chapter,,)48, as provided)n Seotlon application Is hereby made
by ) G
pg(Pull Name of person,Firm or Corp
ratlorf
of �.. ( one
Num
�r)
(Address;street or P,O,Box,City or Town,Zip ode)
for per misstan to(state clearly purpose fOr whlgh permit)s requested)
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Name of Competent Operator(if applicable) 6' 61,
Cert No,
Date Issued rejected BY
(signature of Appilcant)
Date of expiration Fee Amount Paid$
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(Rev.1,1,2016) PERNT
City or Town: D�/ DIG SAFE NUMBER
Date: C G
Permit Number(if applicable); Start Date:
In accordance with the provisions of M,G,L,Chapter 148,as provided In this permit is granted
(Full Name of person,Firm or corporation)
for
Restrictions:
at ; rn
Or and*or Do cdbe Looaflon for Adequete identificallon)
Fee Paid$ This permit Will expire on Z�`��
Signature of Official Granting Permit.
This permit must he C"n� >lCuousiy posted yap in the prom fis
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