HomeMy WebLinkAboutFire Sprinkler permit - Sprinkler Permit - 12/5/2012 rcf - �r' 'zite �ril�e CMG cr,
FP6(rev.3/00)
APPLICAI 'ION FOR PERMIT
City or Town _ LL ' ' DIG SAFE NUMBER
Date
Saari Date;
-In accordance with the provisions of M.G.L.Chapter 148 as provided in Section application is hereby made
by LZ
(Ff41 name of person,FT or corporation)
Address °� ,� � ° a 6
(Streator P.O.Bar)(city rTovm)
For permission to (st to clearly purpo " for which permit:is requested) rt �' - (A' !
Name of competent operator(If Applicable) Mi ' ��� Cert. No. 6)ej
Date By
(Signature oiAppticant)
Date of expiration Fee _� $Paid
k WX'�
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FPS(rev.3/00) - �. 00 �����-V �i�LG J Q4KQD 0! 77,5_
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City or Town , DIG sarE NUNIBER
Bate
Start Date:
Permit Number(if applicable)
In accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
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to V-1
q (Full name o/ioe =rson,Firm or Corporation)
for L —
AI�dr ( of fl r!
1
Restrictions:
at c
(Give location by street and no.,or describe in su 'ch manner as to provide adequate identification of location)
Fee Paid S This.Perr nit will expire on _U ��
Signature of Official Granting Permit p Title
This permit mu.st be cores is u usly posted upon the premises 4M.
SC:
ROAD
21/2014