HomeMy WebLinkAboutFire Dept Permit - Permits - 1211 OSGOOD STREET 9/18/2012 FPS(rev.3/00) l/. ✓VOz '0��� lJ Cti U G�Li
APPLICATION FOR PERMIT
` _ EStartDate:
G SAFE NUMBER
City or Town J Is---
Date e J C'
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by (Full name of person,Firm or CorPoralien)
/f Address
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(Street or P.D.Box)(City or Town)
For permission to (state clearly purpose for which permit is requested)
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+ ��. S �Py:v, Z,� a Gent. No.
Name.of competent operator(If Applicable) �_
Date Issued-F:;- ed _ By +` ''
/� 1 (Signature A licartl)
Date of expiration �L/00/1 C Del Fee Paid — 2!�� ZZ7 Due ---
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PERMIT
DIG SAFE NUMBER
City or Town 1, ---
Date _
Start Date:
Permit Number (if applicable)
this permit is granted
In accordance with the provisions of M.G.L. Chapter 148, as provided in
Ada L Cr
to
. (Full name of person,Firm or Corporation) f
for
Restrictions:
Ir
at
(Give . ation by street and no.,or describe'in such manner as to provide adequate identification allocation
p v This Permit will-expire on
Fee Paid $
Signature of,Official Granting Permit
Title %'
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