HomeMy WebLinkAboutRadio Box installation permit - Permits - 466 SUTTON STREET 3/22/2016 7 S-- 0000
The Commonwealth of Massachusetts
r
Department of Fire Services
Officeof the te Fire Marshal
Y _ R O.Box 1025 State Road, 5
�v ad,Stow,MA 0177
APPLICATION FOR PERMIT
Date:
Ae 1j-) C/ 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 W �h1L� A-1-4 � S xl S-�)
(Full name of person,Firm or Corporation)
State clearly Address C�� cr( � K �® L �4,.
purpose for (Street or P.O.Box City(or Town)
which permit For permission to
is requested
Comments: /I__ /I --
at y S v 7`—o S
(Give location by street and no.,or describe in such manner as to provied adequate identifica ion of location)
Name of competent operator aLe-�4- {�/��p��®„i' Cert.No. C( � ( I
(If Applicable)
Date Issued-rejected By
(Signature of Applicant)
Date of expiration Fee 0 , Paid Due
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The Commonwealth of Massachusetts
aDepartment of Fire Services
- � Y Office of the State Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775
Date:
U(/v hermit No PERMIT
Dig Safe Number(City of Town) (If Applicable)
In accordance with the provisions of M.G.L. Chapter as provided in section
r( / Start Date
This Permit is granted to: (,J R`��— 4g-4A—r, s'41--�
/ Full name of erson,Firm or Corporation L
Permission to Wf l�SC -( � �� C ACC c� -�O e X l 3 I ?), -f l Ce -5,x j �
Z2 C
Comments:
Restrictions:
at �6 t7 S'v 74 0 1 S -r` N o <--I- Ifs' p vJ-�
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid$
This Permit will expireLp" {Signature of fricdlr' t g permit i' (Title)
t
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