HomeMy WebLinkAboutRadio box installation permit - Permits - 10 COMMERCE WAY 3/23/2016 Department of FQffe Services�( �a
ffice of the State Fire Marshag
�! P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT.
Date: J,/r,�-.31 J,tj
Permit No
(City or Town) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter as
provided in Section application is hereby made Start Date
by S f� ��QC T�Ztji CeAtfq(foe
(Full name of person,Firm or Corporate
State clearly Address Qlve`d �1 ��f` !IC�O✓�� v` �+ ��
purpose for (Street or P.O.Box City or Town)
whichpermit Forpennissionto SASJ-1iI C( SAS U11001 CO MO/l.
is requested s finsAn 1 re alfi
Comments:
at U L-'M r'� k tA T J+'r /� (f � �i +1
(Give location by stre and no.,or describe in such manner as o provied adequate identification of location)
Name of competent operator �ic/1t 5 � Cert.No. (� 5
(If Applicable)
Date Issued-rejected By
A7(Signature of Applicant)
Date of expiration Fee Paid Due
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°The Commonwealth of Massachusetts
- > Department of Fire Services
0
,QI Office of the State Fire Marshal
" P.0.Box 1025 State Road,Stow,MA 01775
Permit No PERMIT Date:
(City of Town) (If Applicable) Dig Safe Number
In accordance with the provisions of IvI_GL. Chapter as provided in section
j Start Date
This Permit is granted to:
y Full name of person,Firm or Corporation .
Permissionto yn.S IK q &SM ceti rir ( iG if
Comments:
Restrictions: j/7 TG: � j(�
at (D C �ccp VoM @ ovlor '.I TA'
TA' () i t1 . t f/c
(eve location by street d no.,or describe in such manner as to provied adequate identification of location)
Fee Paid$ �'� f�lsZ _Ci�
This Permit will expire 6 t 0-4 101wl-' (Signature of offical granting permit) Offical granting permit (Title)
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