HomeMy WebLinkAboutFire Dept Permit - Permits - 4/23/2012 :; � L/C�Ze �4991/7724�J2•GIJEIZ�� Q���//(�CLy,1��C�G(/.�G't�.l �
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APPLICATION FOR PERMIT
=Date:
UMBER
City or Town ' 1
Date �� ® �� - � �
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by f
tt (Fullnameofpe on,'F orCorpo:2tien)
Address
(Street of-P.O.Box)(City or Town) J
For permission to (state clearly purpose for which permit is requested) i�' // C:C � ? � l ✓ -�l 1
`? /y / I
Name.of competent operator(If Applicable) �`✓��t -r Cert. No.
ff
Date Issued-rejettsd— J -/-2--- By
(Signature of Applicant)
Date of expiration 6�i0���%� Feer $ Paid�/� Due
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(rev.3/00) 9. Ooq; �J� 614e,
PERMIT
Dity or Town ,/®"� �/> �'����. DIG SAFE NUMBER
Date
Start Date:
'ermit Number (if applicable)
n accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
` (Kull name of person,Firm or Corporation)
iestrictions:
(Give location by street and no.,or describe in such manner as to prcv6e adequate identification allocation) .
ee Paid $ - This Permit will expire on -4
ignature oP,Officia) Gr�nting Perm )Title ��,,
.-..-� •�•, - - �1 r, ,-f-rl i•�%n