HomeMy WebLinkAboutFire Dept permit - Permits - 1/20/2011 001rv22aa1n-u�.al� cl ��czyuzc
's - �Ou7 =�itn Pin 61/- �c��e �-zc�eJ
FP6(rev.3/00) ✓V�r % t�2�, U CG U GaGl�, ��
APPLICATION FOR PERMIT
r DIG SAFE NUMBER
City or Town c' -yK
Date
Sta7Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
(Full name of person,Firm or Corporation)
Address t-ce-- tv-1 no q
(Street at P.O.Box)(City or Town)
For permission to (state clearly purpose for which permit is requested)
Name.of competent operator (If Applicable) ° i'Lki'L ` t Cert. No. ) �'j—)
Date Issued-Fe*te-d— !— d %/ By
(Signature at Applicant)
r �`_
Date of expiration r� oil Fee $ Paid Due
------ — ------------------------- ...� --------_—
3(rev.3/00) C/CJOZ % 0,0)5, (;%4e,
PERMIT
City or Town G!/ �lw fi DIG SAFE NUMBER
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
(Full naaleat person,Firm or Corporation)
for
restrictions:
3t —,V- z 0/ �� �i �/t ra.� I C
(Give location by street and no.,or describe in such manner as to provide adequate identifications 0110c2h0n) .
=ee Paid $ This Permit will expire on i1 nc%r(
Title
Signature of,Official Granting Permit
+hn nrnmicoc eLr'