HomeMy WebLinkAboutFire Dept permit - Permits - 4/13/2011 z ��iea��v»z�2u�ea�
FP6(rev.3/00) O!x
APPLICATION FOR PERMIT
=Date�.:
UMBER
City or Town
Date
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by
(Full name of
person,Firm or corporation)
Address Zl
(Street or P.O.Box)(City or Town)
For permission too�(state clearly purpose for which permit is requested)
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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FP6(rev.3/00)
PERMIT
City or Town
� y�yjd7 ' F' DIG SAFE NUMBER
Date
Start Date:
Permit Number (if applicable)
In accordance with the provisions of M.G.L. Chapter 148, as provided in 7Z-/1� this permit is granted
to_ <` e� l ✓ 1/ / cilia
// (Full name of person,Firm or Corporation)
for tye'o P kvta G� �`G rlP 1 �"'G e°�� 4,2/
Restrictions:��as✓�/j �'� 'V-Aror zsu";Ez Ais Z,at 11F.To-k-7viA ,
(Give�oca lion by street and no.,or describe in such manner as to provide adequate identification of location)
Fee Paid $ 5 — his Permit will expire on
Signature of,Official Granting Permit -- '" f itle
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