HomeMy WebLinkAboutRadio Box installation permit - Permits - 165 FLAGSHIP DRIVE 10/15/2015 C/L/
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1 DIG SAFE NUMBER
Date: APPLICATION FOR PERMIT S TAR7 D.4,TE
C.82 S.40 M.G.L.
To: Head of Fire Department: A40 I(JA-
City/Town
In accordance with the provisions of Chapter 148,M.G.L. as provided in Section application is hereby made by:
Name z
(Full name of person.firm or corporation)
Address: (Street or P.O.Box) (city/Town) (State) (Zip Code)
For Permission to: A
State clearly the purpose for which the permit is requested:
Location:
Name of competent operator4applicalle: Certificate of Competency#:
Date Issued { —rDate Rejected I By:
Date of Expiration: 1
Fee Paid I } Fee Due Amount:
licant Signatur� Fire Department Number:
(If Applicable)
X (If—Ap-p—licable)
0 a a 9 K 2 0*BREMEN MEN r r r r r r r r r r r r r r r r r r r r m r mass mannonso
Z"
"P' 9026, Q 9(20/ O�776-
DIG SAFE NUMBER
Date: PERMIT,
C.82 S.40 M.G.L. START DATE:
In accordance with the provisions of Chapter 148, M.G.L. as provided in Section this permit is granted to:
Name:
(Fu-) name of person,finnur corporation)
ForFor Permission to: S-
_It_ , *c(/6 6
State clearly the purpose for-irv&ch the permit is granted:
Restrictions:
Location:
Fee Paid: Z) This Expire On:
Signature and Title of Official Granting Permit: =77
=:>(THis PERMIT MUST BE CONSP—IVU'OUSL'"OSTED UPON THE PREMISES.)