HomeMy WebLinkAboutRadio Box installation permit - Permits - 525 TURNPIKE STREET 12/2/2015 Application for Standard Permit
FP-006 .► Return completed application to:
(Rev. 1.1.2015)
Permit Number: l DIG SAFE NUMBER
City or Town: /X 4�01-k-
Date: �-
Start Date:
! � - �-1
In accordance with the provisions of M.G.L. Chapter 148,as provided in Section application is hereby made
by �zv✓ta2jc2' 9 �r ^Z f7/yam f
(Full Name of Person Firm or Corporation) (Phone Number)
(Address:Street or P.O.6ox,City or Town,Zip Code) /
for permission to(state clearly purpose for which permit is requested) ,7 rzazl
Name of Competent Operator(if applicable) ` Cert. No.
Date Issued-rejected By -ICJlan Lail also
(Signature of Applicant)
Date of expiration Fee Amount Paid$
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POP
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FP-006
(Rev. 1.1.2015) PERMIT
City or Town: 0EA Ain elv✓2r- DIG SAFE NUMBER
Date: /�� a-E
Start Date:
Permit Number(if applicable):
In accordance with the provisions of M.G.L. Chapter 1488,as provided in this permit is granted
to �+�t r r e
(Full -me
of Person,,Firm or Corporation)
for % f � l.�� b+/��� -7-7I/ C 7 ?i �/--
Restrictions:
at Pff A"!'"�--a&i'5c4e--
(Street and#or Describe Location for Adequate Identification) /
Fee Paid$ This permit will expire on U Now
Signature of Official Granting Permit: Title ii?£
This permit must be conspicuously posted upon the premises