HomeMy WebLinkAboutFire Dept permit - Permits - 9/23/2011 C��GcG`e
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FP6(rev.3/00) '0�� UCe � CGCG, ULOGI�, C�0007775
APPLICATION FOR PERMIT
City or Town
DIG SAFE NUMBER
/� /���
Date /<
Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by 9YT7_S,--�S //2C
(Full na erson,Fi or Corporation)
Address I
(Street or P.O.Box)(City or Town)
For permission to (state clearly purpose for which permit is requested)
QJ
ZR �7C
Name.of competent operator(If Applicable)
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Date Issued-rejected By
(Signature of Applicant)
Date of expiration Fee $ Paid Due
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6(rev.3/00) ( OZ % 0'2j'
PERMIT
City or Town ��vex\— DIG SAFE=�NUMIBIER .
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 � {'2a% �V S7" S /l L
(Full n me of person,Firm orporatio )
for .S 774& .47� D�"�t0 L 2 �l
Restrictions:
at
(Give location by street and no.,or describe in such manner as to provide adequate identification of location) ,
Fee Paid $ This Perm it~will expire on10
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Title'
of-Official Granting Per