HomeMy WebLinkAboutSprinkler permit - Sprinkler Permit - 78-80 UNION STREET 12/2/2011 : -�_��--_�_ ���ie �a��v»aa�r�•c�ea��-c. a�G��cz:�.uzc�c�e�`.� �
.„ ='• r��icr��(irrr��t-rl`a����e��=u>;^ceJ= ����e a���ie CJCaG`e ���e C�G"Lcr���:1�cz� ''`
FP6(rev.3/00)
APP-LICATION FOR PERMIT
y �N 1 �� f =Date:
UMBER
City or Town G
Date 12-- 2 It
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by
(Full name of person,•Frrm or Corporation)
Address
G C z -��, :� - L P y j-
(Street orP.O.Box)(City or Town) /
For permission to (state clearly purpose for which permit is requested)
K.ert S u S � �
7� - CFO
Name.of competent operator(If Applicable) i� wd � ��• Cent. No. d L L
rcDate Issued-reMCte-d-./1—� _/� By — lz!%�
a n ture of Applicant)
Date of expiration _ UpU. ��.�� .Try., Fee w $ Paid Due
--------------------
(rev.3/00)
PERMIT
;ity or Town fT// .`.`� �d�vfi/ DIG SAFE NUMBER
ate
Start Date:
ermit Number(if applicable)
accordance witthh�the provisions of MM..jG.L. Chapter 148, as provided in this permit is granted
f/ (Full name
of person,Firm or Co(pora
ti
on)
r �// �l/� G c��`C[Fib LG�iZ,'/Jf� i2 c�11�✓
;strictions:
U4 �
(Give location by street and no.,or describe in such manner as to provide adequate identification ollocation) .
e Paid $ S This Permit will expire on
;nature of,Official Granti g Perm Title