HomeMy WebLinkAboutFire Dept permit - Permits - 430 OSGOOD STREET 1/18/2012 -1%j, L/C�Z2077Ti7720�2GllElICGYC 4��%�LCL}SCZCf2•G(/1�' j j/
V—q . �2airfit7 r�l`o c��e. -vc�eJ^-, cce C 4iie CJ
FP6(rev.3/00) ✓ ✓VOZ 1 �G�� U[ 2 GJ UGOL11� �,��� ��/ �5
APPLICATION FOR PERMIT
�rt�� Ado
0�r— =Date:
UMBER
City or Town /V
Date K 6�0
}
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 Corporal J
Address �� (_ oyl -C� C1� C� { �k And i 01
(Street or P.O.Box)(City or Town)
For permission to (state clearly
\purpose for which permit is requested)
Name.of competent operator(If Applicable) ASS ���� Cert. No.
Date Issued-rejected I / By
�
(Signature at Applicant)
Date of expiration `moo ����✓� Fee $ Paid Due
i go. V P/Ir2lGCPd• — .���i ce o� ie CJ�cz�e�'�ri��e � ti
6(rev.3/00) C/CIOZ -0,05, C5� , aL �0- 775
PERMIT
City or Town x l DIG SAFE NUMBER
Date f
Start Date:
Permit Number (if applicable)
In accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
i (ruli name of person,Firm or corporation)
for
Restrictions:
at e!�''- C <<i c s/ d
(Give location by street and no.,or describe in such manner as to provide adequate id fication of location) .
= This ee Paid $ Permit will expire on
7;
Signature of,Official Granting Permit Title _,% X L s'€
.. ... . 'o