HomeMy WebLinkAboutFire Dept Permit - Permits - 8/15/2012 _ �/G�.e �499'1U79Z4�J2-G1J-2C2'�� Q��%•v[�L�':�lCf2•G!/.lG'�,1•
FF6(rev.3/00)
APPLICATION FOR PERMIT
j��s DIG SAFE NUMBER
City or Town / � j
Date t115 X0�1
Start Date:
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 corporation)
Address
(Street or P.O.Box)(City or Town)) —�
For permission to (state clearly purpose for which permit is requested) / / .Cif%iQOT
�1"73
Name.of.competent operator(if Applicable) 0 ! ,,—,e"`'—Jye j-- Cert. No.
Date Issued-K4&&ed- By �!-/
!
( (Signature of pplicant)
Date of expiration 0P00n Fee $ Paid =- Due
ern
(rev.3/00) (/VOZ '�G�� (JIJ IJJ CJI�GI�� 0�7JJ
PERMIT
amity or Town ✓ fY.? ��s�_ DIG =�NUMEBER .
Date
Date:
'ermit Number (if applicable) :Start.
n accordance with the provisions of M.G.L.sClhapte�r 148, as provided in this permit is granted
/ g(Full name of person,Firm or Corporation)o
Dr
lestrictions:
(Give location by street and no.,or describe'in such manner as to provide adequate identification o(localion)
ee Paid $ This Permit will expire on
Title
ignature of Official Grantin Permit
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