HomeMy WebLinkAboutRadio Box installation permit - Permits - 10/22/2014 :: C���-re �a�rva�ao�n-c�2a�� a�G��czyuzcf c�rte�t
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APPLICATION' FOR PERtMJI F
DIG SAFE NUMBER
City or Town 6°z(
-Date r9 '
Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by ��� r2�~t" 5sirv�t5 �=
(Full name of person,Firm or Corporation)
Address s:> �� t c1 r tom : f�� �� ;��s f �3 c i95
(street orF.o.Box)(Cit) rTown)
For permission to (state clearly purpose for which permit is requested) Rr, E T-kN Q
Name.of competent operator(If Applicable)` `` `� a �"�� _ Cert. No.
Date Issued-refe� /6 —,'--L 6/ By
(Signature of Applicant)
Date of expiration (lpG1� Fee 7 $ Paid — Due
Date of expiration l-ee �i Naid uue
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PERMIT
Jty or Town D1G SAFE NUMBER
ate
` :,St:ar-tDate:
ermit Number (if applicable)
i accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
(Full name of person,Firm or Corporation)
r f�f<°1�z" Cx<`si�r� ti /1%/��✓fir �oK r�//�' �f//yL.�.z. C f,��nra� c /����
estrictions: ion., r a
(Give location by street Ad no.,or describe'in such manner as to provide adequate identification of location) .
=e Paid $ T is Permit will expire on !»6v?
Title
gnature of�Official Granting Permit �irf
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