HomeMy WebLinkAboutFire Dept permit - Permits - 49 ORCHARD HILL ROAD 11/16/2011 4g�1i79ZO�J2-Gt1�Cx Q.` y:SCGCf2•G!/.1�'�J.
FPS(rev.3/00) �aZ 7���, l/t e �, lam/GOlI�, �O�/775
APPLICATION FOR PERMIT
DIG S=NUMBER
City or Town Al , �>
DateNov" / 6 2-um Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by L t- --
(Full name of person,•Firm or Corporation)
Address
(Street or P.O.sox)(City or Town)
For permission to (state clearly purpose for which permit is requested) � l
0
t.I Li
r
Name.of competent operator(If Applicable) -=`t Cert. No.
./A
Date Issued-raieeted BY
m (Signature of Applicant)
Date of expiration 00 Fee Cam.. 0— S Paid �. Due
S- - ________
-__=__------------------------------
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DS(rev.3/00)
PERMIT
City or Town V DIG SAFE NUMBER
Date N ov I ? U l I
Start Date:
Permit Number (if applicable)
In accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
to �`
!', f'�� L
-
(Fuli name of person,Firm or Corporation)
for Ii1c A1.Aa1
Restrictions:
at '
(Give location by street and no.,or describe in such manner as to provide adequate identification of location) .
Fee Paid $ �5�� This Permit will expire on
21&4
Signature of"Official Granting Permit
® Title