HomeMy WebLinkAboutFire Dept permit - Permits - 12/2/2011 ���ie �Ga��v»ao��2•cr�2a�� a�C��yuzc�-c�-e�`.�
FP6 (rev.3/00)
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APPLICATION FOR PERMIT
DIG SAFE NUMBER
City or Town / v ���T--rov0-11-1—
Date /a I / Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section —
application is hereby made
by
lsr�ll name of perso , r r Corporati°n)
Address_
• (Street or P.O.Box)(City or To
wn)
For permissio to (state clearly purpose for why ich permit is requested) •
Name.of competent operator(If Applicable) ��� �o t'1 �— C /
Date Issued-rejected // By
Jsrgnature of Applicant)
i(/ •� ��$ Paid Due
Date of expiration (�i��'lt ,���� � Fee _-- _
___=---------------------------
(rev.3/00) ( QZ �'0'2.5,
PERMIT
;ity or Town DIG DIG SAFE NUMBER
)ate 42, �2'0
Start Date:
'ermit Number(if applicable)
i accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
—1�, (Full name of person,Firm or Corpora' n)—
estrictions:
cv—
(Give location by street and no.,or describe in such manner as to provide adequate identification of location) .
.e Paid $ This Permit will expire on = :Z?ee t ?""x-/
Title Z�7 �
gnature of,Official Grantng Per � � � C`'1