HomeMy WebLinkAboutRadio Box installation permit - Permits - 10/6/2013 '6(rev.3100) /�j///�J //✓1 7//�/� /� r CI C / (/ '^(� A y7 APPLICATION FOR PERMIT
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City or Town :-:��rl r� �=7�Gr�
'Date
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
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(Full name of person,Firm or Corporation)
Address eon
(street or P.O.EA(Ci or Town) /
For permission to (state clearly purpose for which permit is requested)-..
Name.of competent operator(If Applicable) �<�- ��t---�,h,'`��- ert. No.
Date Issued-r ' —
e�eeted- /�— /l.� � By
(Signature of Applicant)
Date of expiration Fee S $ Paid CD Due
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PERMIT
;ity or Town /2�� 6 ' ���` '— DIG SAFE NUMBER
late
[Start Date: _
ermit Number (if applicable)
i accordance with the.provisiioonss of M.G.L. Chapter 148, ass provided in this permit is granted
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(Full name of person,Firm or Corporation)
estrictions:
(Give location by street and no.,or describe'in such manner as to provide adequate identification of location) .
se Paid $ � This Permit will expire on I-lpG,
Title
ignature of,Official Granting Permit f�= Cuff`
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