HomeMy WebLinkAboutRadio Box installation permit - Permits - 72 ELM STREET 3/17/2014 7
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DIG SAFE N(J M SE R
Date APPLICATION FOR PERMIT 71 IR T DATE
C. 82 5,4 CY 1./G L.
To: Head of "ire Department: ()i, 1 Illycl
City /Town
Ln accordance with the provisions of Chapter 148, N/t G.L. as provided Lri Section Uplicanon Is hereby made by
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(Full allme at person.n 7 a,corporan I
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Address.
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For Perrrussion to: All
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State clea Irl-y he purpose [or, hich Pe is request
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Name of competent operator Lf applicable: Y".L"r e J Certificate of Competency #:
Date Issued ( ; Date Rejected 1 1)1 By:
Date of Expiration: /i Fee Paid Fee Due Amount:
Applicant Signature
-7-1 17_ Fire De�partmeat Number-
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DIG SAFE NUMBER
Date: PEPMIT
C.82 S.40 M.d.L. STAR.TDATE:
In accordance with the provisions of Chapter 148, M.G.L. as provided in Section this permit is granted ro-.
Name:
(Full rwmolpersou farm orCorpora on)
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For Perr�ission for i 6 X� i c�/,�,-, 11 P -
State clearly the p Ose foT which the permit isgranted:
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Restrictions:
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Location. 1 (;,"'I C�,
Fee Paid: This Permit Wiu Expire On: t2 0V 77 0- 4_7
Signature and Title of Official Granting Pmmit:
=z, Cis PmmTMus"rBE ONSPtcUb-USLY FOOD UPON THE PR-MSES.)