HomeMy WebLinkAboutFire Dept permit - Permits - 158 MAIN STREET 2/24/2011 FP6(rev.3/00) c ax 70�� v l C Loll, QA2,Q Q'77'5
APPLICATION FOR PERMIT
EStarlDate:
G SAFE NUMBER
City or Town ^�� - � 4�z
Date
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by _&2r�Q2,1,4 '
(F It na e of person,Firm or Corporation)
ti Address �' �t�° � ,�'� L-;l �l'l � ���3
(Street or F. .Box)(City or Town)
For permission to (state clearly purpose for which permit is requested) ESQ= f ✓� C, t� c
sS � 7-- - ,
Name,of competent operator (If Applicable)` _ Cert. No.
Date Issued-rafe-c d / By A,
(Siq ureofApplicant)
Date of expiration !�r�bn G-�����'� Fee $ Paid Due
'6(rev.3/00)
PERMIT
City or Town 2 /y//�0��� DIG SAFE NUMBER
Date r2
Start Date:
Permit Number (if applicable)
In accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
(Full name of person,Firm or Co�)
for
Restrictions:
at
(Give location by street and no.,or describe in such manner as to prov e adequate identification on ocahon) .
Fee Paid $ __ _ _ This Permit will expire on 'o Ir T�®T
Signature of,Official Gr nting Per p Title'