HomeMy WebLinkAboutFire Dept permit - Permits - 11/4/2011 (3) _ L/C� �4g9U79ZOiI2•GU�CZC�• a��%U(�Ly:SCGCf2•G(/.1G'r�.� �
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' APPLICATION FOR PERMIT
DIG SAFE NUMBER
City or Town No('� �&0,J kA1
Date Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by1
(Full name of person,-Finn or co(poration)
Address C n S 'R C SPA-- U"2-t
(Street or P.O.Box)(city or Town)
For permission to (state clearly purpose for which permit is requested) TCrQ- 4L+
►�•Fc NMC.�`n S—lam 1sa1\ C 251 /' p � , G
Name.of competent operator(If Applicable) Cert. No.
Date Issued-rejected By
(Signature of Applicant)
Date of expiration Fee $ Paid Due
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:16(rev.3/00)
PERMIT
City or Town /y �lJ�/��/ �� DIG SAFE NUMBER
Date ,//
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
} (Full name of person,Firm or corporation)
for !� it l/�G�•a a/ zp
Restrictions:
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(Give location by street and no.,or describe in such manner as ldplrovide adequate identification of location) .
Fee Paid $_ � This Per
Title
signature of Official Granting Permit �i ice[ �t ems'