HomeMy WebLinkAboutRadio Box installation permit - Permits - 12/13/2011 FP6(rev.3/00) c
APPLICATION FOR PERMIT
NO!" DIG SAFE NUMBER
City or Town
Date L
Start Date:
In accordance with the provisions 1of^ M.G.L. Chapter 148, as provided in Section application is hereby made
by
(Full
,name Of person,•Firmo/rCo(poratien) �—� . Ott")
Address
(Street or P.O.Box)(City or Town)
For permission to (state clearly purpose for which permit is requested) ��254'
Name.of competent operator(if Applicable) _ t�c,� � �� � Cert. No. 7r 7 C
Date Issued-rejected By
(Signature of Applicant)
Date of expiration Fee $ Paid Due
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3(rev.3/00) , L/• Ci% l v�aGl1, QALLX�
PERMIT
1
City or Town (+� AA'CJ DIG SAFE NUMBER
Date
Start Date:
Permit Number (if applicable)
In accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
to 5 fey z t 9,,`�
L � 6 ) z i
// (Full name ofperson,Firm or Corporation)
for
Restrictions: j
at
(Give location by street and no.,or describe In such manner as to provide adequate identification of Iecafion) .
ee Paid $ This rmit will expire on (won �� ��.�, �
Signature of'Official Granting Pe
•• Title
t,t /
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