HomeMy WebLinkAboutFire eDept Permit - Permits - 2/3/2012 3100) I,005, g9&&Roaal, Q46-11/ W 776
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APPLICATION FOR PERMtT
DIC SAFE W U M 5 E R
City or Town Oc I
[ ate , _ ) _ Y Start Date:In accordance with 1he provisions of M.G.L.Chapter 148, as provided in Section application is hereby made
L-)Y Firm or Corporation)(ruff name ofpamorz,F
Address pfrzct cvp.a.Bob(CkyT—n) gg
mar permission to (state clearly purpose for whj'ch permit is requested)
Name of competent operator(If Applicable) Cert. NO.
0 2 'M
Date issued-rejected By (S7g=hoe 2of ApOc:�M
Date of expiration Fee Paid Due
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077 �
FS (rey
PERM-IT
City orT6wn DIG SAFE NUMBER
Date
Start Date,
Permit Number applicable) C this permit is granted
In accordance with the provisions Of M.G,L. Chapter 148, as provided in
to
parson,Pirrn or Corporatiori)
for
Restrictions'.
at
(Give iccalrw i)y street anc ra.,or describe in surd manner as to provide adaqusre iderWh'calion of
- hi
Foe Paid $ Thi's'Permit will-expire on
Signature of Official Granting Perm' 'e Title
Pr it b"M upon the premises *K
N* This PerMit be consoicuousiv posted u
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