HomeMy WebLinkAboutRadio box installation permit - Permits - 30 OLD CLARK ROAD 12/15/2016 r-7
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DIG SAFE NUMBER
)ate: APPLICATION FOR PERMIT
START DATE:
82 S.401M.G./L.
Co: Head of Fire Department: 4,11 -, ok,/
City/Town
n accordance with the provisions of Chapter 148,M.G.L. as provided in Section application is hereby-made by:
',lame: Z,
(full name of person.firm or corporation)
kddress: 7 z ',�4/
,—c r
(Sweetor P.O.Box) IC' own) (State) (Zip Code)
or Permission to:
hate cl rly e purpose for which th pem ift is requested:
ic
'location:
qame of competent operator if applicable: 'lDr-Y,— J) ell-, Certificate of Competency#: -2 3 7
)ate Issued { } Date Rejected f By:
)ate of Expiration, Fee Paid Fee Due Amount:
kpplicant Signature:= P, �--s Fire Department Number:
(If Applicable)
------------
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Muz 7025, Q 0-1775
Dic;SAFE NUMBER
ate: PERMIT
82 S.40 M.G.L. START DATE:
accordance with the provisions of Chapter 148,M.G.L. as provided in Section this permit is granted to:
ame:z—j 14/4 P q 't
um or corporation)
(Full name of p=on,f
)r Per fission to:
-alp arly the purpose for Which the is oed: 4,
Ucl;o 7L0 Flu—
astrictions:
Dcation:
;e Paid: erm;'This P toW' on
a
gnature and Title of Official Granting Permit:
=>(Tius PERmrr MUST BE CONSPICUOUSLY POSTED UPON THE PREmism.)