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APPLICATION FOR PERMIT
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G SAFE NUMBER
City or Tow/n�}
Date
In accordance with the provisions of M.G.L. Chapter 148, as provided in /Section application is hereby made
by EC
. (Full name of erson,Firm or corporaticn)
Address kt
(Street or P.O.Box)(City or Town
For permission to (state clearly purpose for which permit is requested)
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aw
r 1 .
Name.of competent operator(If Applicable) __ Cert. No.
Date Issued- , 9 BY
(Signature o(Appficant)
Date of expiration t 0L ;""r',Yvl i0 Fee ), $ Paid Due
LEONAp,D ELECTRICY--INC'
Industrial, Residential,Commercial Wiring
Duality Fire Alarm Systems
Mark DeChiara
Project Manager
Commercial Division
Tel 978 937-8620
154 Fletcher Street Cell 508 509-5278
Lowell,MA 01854
Fax 978 452-9613
E-mail:mdechiara@leonardeiectric.com
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APPLICATION FOR PERWT
City or Town &JUJek— DIG SAFE NUMBER
Date /o
Start Date:
In accordance with
the provisions of M.G.L. Chapter 148, as provided in /Section application is hereby made
by
(Full name o/ erson,Firm a(Co(poration)
Address
(Street or F.O.Box)(City or Town)
For permission to (state clearly purpose for which permit is requested)
Name.of competent operator(If Applicable) Cert. No.
Date Issued-rejected By
(Signature of Applicant)
Date of expiration Fee $ Paid Due
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(rev.3/00) ✓ c ax 70,05, 614e RLCL2,
PERMIT
;ity or Tcwn ` DIG SAFE NUMBER
)ate
Start Date:
'ermit Number (if applicable)
i accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
(Full name of person,Firm arCarporalian)
estrictions:
(Lob
(Give localion by street and no.,or describe in such manner as to provide adequate idenldication a/localron)
�e Paid S� This Permit will expire on U(0 Uc� ��� ✓r�''�
gnature of,Official Granti
ng Per Title
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