HomeMy WebLinkAboutRadio Box installation permit - Permits - 70 FLAGSHIP DRIVE 12/20/2015 Pf", .-Malk'I
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DIG SAFE NUMBER
)ate: APPLICATION FOR PERMIT START DATE
2. 8.2 S.40 M.G!L. AB f
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ro: Read of Fire Department: /C el /Lilt
City/Town
In accordance with the provisions of Chapter 148, M.G.L. as provided in Section application is hereby made by:
Name: P,vi�7,(�),,
(Full nc of person.Finn orcorporation)
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Address: (StIta or F.U,B01) (Zip Codc)
For PemAssion to:
State clearly the purpose for which the permit is requested:
All
Location.: 70 Lrlirngli,' ry
Name of competent operator if applicable: Certificate of Competency #: 2Z 7 5—
Date Issued { } Date Rejected 'I: By:
Date of'Expiration: Fee Paid Fee Due Amount:
Applicant Signature: Fire Department Number: (If Applicable)
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�CDZI -1775
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PERART DIG SAFE NUMBER
)ate:
82 S.40 M.G.L./ START DATE:
a accordance with the provisions of Chapter 148, M.G.L. as provided in Section this IDeTniit is granted to:
fame:
(Full name of pm-=,#1mor rporadonl
or Perniission to cr
tate clearly the purpose far which the ermit is granted:
estriction's..
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:)Cation:
.e Paid: This Permit Will Expire On:
gnature and Title of Official Granting Permit:
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==>(TBis PERMIT MUST BE CONSPICUOUSLY FOS'TTT)VpoN