HomeMy WebLinkAboutFire Dept Permit - Permits - 15 CHARLES STREET 10/18/2012 J• ��e �Ga�rv»za�n•ucz� c aC��cz�sczcc�eG�`�
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APPLICATION,FOR PERMIT
�( 1�i =Date:
UMBER
City or Town / X W,44r ,�3�c
Date Start
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
14
AID 441/4�_2 --,�51( 7 7-
by
(Full name of person,-Firm or CorporatianJ
Address
(Street or P.O.Box)(City orToivn)
For permission to (state clearly purpose for which permit is requested)
Vame.of competent operator(If Applicable) Cert. No.
)ate By
(Signature of Applicant)
)ate of expiration (�J°®h��i<�2 Fee �� Paid �� Due
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rev.3/00) ✓CJO� -0,05, p•Gcc�_, 20-,u7 ,
PIS'
ity or Town <! �� y��� DIG SAFE NUMBER
ate -
Start Date:
=it Number (if applicable)
accordance with the provisions of M.G.L. Chapter 14ka s provide/d� in this permit is granted
i (Full name al person,Firm or corporali e
strictions: 12
(Give location by street and no.,o�describe in such-rrraMeras 10 provide adequatl identti/ifi��callon of lo�caliion) .
= Paid $ _ , _ ---- ThiJll
Titl
nature of Official Granting Pe e
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