HomeMy WebLinkAboutfire permit 12 Millpond Application for Standard Permit
Return completed plated application to: 40
Permit Number,
EDIGAFEMBER
City or Town: P ULIIDate's pi
In accordance with the provision's of KG.L,Chapter.l48, as provided In 5ectlon ` appiication is hereby made
by LIC.L
(Full Name of Person,Plrm or Corporation) (Phone Number)
of
(Afteesi Strest or p.0,Box,Clty or'rown,x1p Code)
for permission to(state dearly purpose for whloh permit Is requested)_ _ a
ref 6. n r- 6,14-S 5i4r 4r 0 le.
Name of Competent Operator(if applicable) ---
Date Issued-rejected ------ By t :, 8
5lgnature of Applicant)
Date of expiration Fee Amount Paid$ _
___ ______a____----....____.»...______-.._____-_-______ m _____________.