HomeMy WebLinkAboutRadio Box installation permit - Permits - 575 CHICKERING ROAD 3/27/2014 7�,
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APPLICATION FOR PER-MIT DIG SA FE W UN BE P
A ST rRT 0a TE
C. 82 S.40
To� Head of Fire Department: Al^` -h
City /Town
fri accordance with the provisions of Chapter 148, M01 as provided Ln Section a-PTD[Lcarion is hereby made by
Name e,- Its C_q1v,.fo&n -,1
(F 11 Paine at persom ri I
Address Pik mk
(stme or P Q,8a1_) (LPI I own)
JZip Cad
For Permission to:
State clearly die purpose for which 4e p t is reques e
Ad-
Location:
Name of competent operator if applicable. ggr4t�Loe Certificate of Competency
Date Issued Date Rejected I By--
Date of Expiration: - I` Fee Paid Fee Due Amount:
Applicant Signatur; _ Fire Departmcat Number-
(If Applicable}
A-M-W-34 am',a®an man m 0 a q W a h•�fk a Ala A C1 3 36 a a a a Q�ja Fs F3 4 A A Fm j d d a 9
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-1775
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Date: PE RMIT DIG SAFE WJMBER
C.82 S.40 NLG,L. STARTOATE:
In accordance with the prDViSi011,9 of Chapter 148, M.G.L. as provided in Section this permit is granted to;
Name:
Permission to: (Fub
For Per Am- 2� 4 Z_
State clearly the purpose fbT wbich e P t is granted:
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Restrictions:
Location: 575- o5qooj -------
Fee Paid-:
-Signature a3:Ld Title Fof Gffic—W_Grantng Ver t:
=-Mus FERMT MUST BE CotNSPICUOUSLY POMD UPON THE PnNusm.)