HomeMy WebLinkAboutFire Dept permit - Permits - 10/26/2011 _ � � /�y� �4��1i7�ZO�I2•GC«CzL�• 0��%v(�CL:�=1CZCf2•G!/,��'�.1• ��
- - �, ,�j; �/ �: . �,CC' ..: __- - ;, �• G�e �C`cr,�e ��� ����Gcza�Jf a� l
FP6(rev.3/00) j. ✓C/Oz i ���� UCH OG���
. APPLICATION FOR PERMIT
DIG SAFE NUMBER
City or Town '�� �`' ✓°'c ve
Date �'r� � Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section_ application is hereby made
byV (Full name o/person,Firm or Corporaatien)
Address ��J \, -
(Street or P.O.Box)(Chl or Town) _
For permission to (state clearly purpose for which permit is requested)
Name.of competent operator (If Applicable) Cert. No.
Date Issued�r
(Signature at Applicant)
� >=---zr- �-s _�
Date of expirationz ' r' ' ` Fee _$ Paid Due
` -
---
-------------
CJ K�(9707'e �� y
16(rev.3/00) ( OZ % 0,25,
PERMIT
City or Town �/��CdO��� DIG SAFE NUMBER
Date
:StartDate:
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 �'•� t'ii:G --Ab�v f io s— !'�v,T
Restrictions:
at �Oy U�fi�a'f/�� crT 3 -
(Give location by street and no.,or describe in such manner•s to pro_vrda ader}uuateadert ficafron of tocahon) .
Fee Paid $ ��� This Per= will ex ire on
.:
Signature of,Official Granting Permit
Title ��1
,�,—� „_.. .a ._____A L..�. .-.r r+.e•.s.i i.s .i-. ,r z i r- r+r�f'r+ 1 1 Yt/'�4"t +k eA o•�r n m i c o c