HomeMy WebLinkAboutFire Dept permit - Permits - 158 MAIN STREET 1/26/2011 i a tl2e CJ
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APPLICATION! FOR PERMIT
DIG SAFE NUMBER
City or Town
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Date ?
Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
N
Y a fi
(Full name of person,Fign or Corporation)
Address ' ' ' Ces
'
(Street or P.O.acx)(City or Town)
For permission to (state clearly purpose for which permit is requested)
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Name.of competent operator (If Applicable) Cert. No.
Date Issued-rejeetLd By
(Signature of Applicant)
Date of expiration VlOcln �Uy!✓ T Fee �� r $ Paid � Due
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City or Town N/1 l��1[/f DIG SAFE NUMBER
Date_ /A1
[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
(Fulln eoft person,
'Firm orCo(poration)
for �'�`
Restrictions:
at
(Give location b street and no.,or describe in such manner as to provide adequate identification allocation) .
Fee Paid $ ,, d(P/ — This Permit will expire on
Title
Signature of,Official Granting f�,ermit �/F
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