HomeMy WebLinkAboutRadio Box installation permit - Permits - 10/21/2015 r:5111 rrtr.arr.uea`l� f jla zr cLsetlJ
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Date: / ® 2 1 2®/-s APPLICATION FOR PERMIT
START DATE'
C. 82 S.40 M.G.L. -
To: Head of Fire Department: /t/®rdf 4 Ot/�
City/Town
In accordance with the provisions of Chapter 148,M.G.L. as provided in Section application is hereby made by:
Name: /-r V o /
(full name ofperson.firm or cor000dtimA
Address: /Ot Ir f • O or�✓/l- '� ® a 3�
(Street or P,O.Box) (City/Town) (State) (Zip Code)
For Permission to:
State clearly the purpose for which the permit is requested: S' a D
Location: `/r/1 ,
Name of competent operator if applicable: Certificate of Competency#:
Date Issued { } Date Rejected { ;: By:
Date of Expiration:,-- Fee Paid { } Fee Due { } Amount:
Applicant SignaturFire Department Number:
(1 Applicable)
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Date: /J PERMIT
START DATE:
C.82 S.40 M.G.L.
in accordance with the provisions of Chapter 148, M.G.L. as provided in Section this permit is granted to:
Name: Zf
(Full `of person,f or corporation)
For Permission to; `'�`/I ✓
State clearly the purpose for which the pern it is granted:
Restrictions:
Location: / `-� ✓11�/7 ��� � 7 -
Fee Paid: --�- This Permit Will Expire On: V00-- %n40
Signature and Title of Official Granting Permit:
(THIS PERMIT MUST BE CONSPICUOUSLY POSTED UPON THE PREMISES.) , /