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APPLICATION FOR PERMIT
=Date:
UMBER
City or Town �� � '��� �;���'.� ��•
Date — �3'- C
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)
a r r
Address f iq
(street or P.O.Box)(City or Town)
7
For permission to (state clearly purpose for which permit is requested) 1
4 f�
y-;
Name.of competent operator (If Applicable)
Cert. No. ,
Date Issued-refe d J Z_.) By
(Signature of Applicant)
Date of expiration (' sx� "? T e,17 Fee Paid— �'i w.. Due
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PERMIT
City or Town � � : ;t ��(�r`(={ 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 this permit is granted
to
(Full name of person,Firm or Corporation)
form c�7fd ( ie.s✓ r%� ���'r��
Restrictions:
at /✓1�f'��r; L j a�G'rsY`7
(Give location by street and no.,or describe in such manner as to provide adequate identification ollocafion)
Fee Paid $_ . — This Pe O'n ec,' 't V,,
Signature of,Official Grantin6 Permi `C Title `T ��< �`'
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1618
License- Joumeyman sprinider i_icense Restricted'tom'
005898 i :01129/2018
Number si
- _
----
435CAMPBELL MILL RD
MASON, NH 03048
442.0
Keep top fbr receipt and change of address notification.
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Boston, Ma 02108-1618
License: Sprinkler Contractor License
Number: SC 001186 Expires:06/06/2013 restricted To: 00
PETER S SALWA
PO BX 701/23 CHARLOTTE ST
S LANCASTER, MA 01551
7r.no: 1241.0
Keep top for receipt and change of address notification.
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