HomeMy WebLinkAboutRadio Box installation permit - Permits - 384 OSGOOD STREET 10/26/2011 /Z'6 0
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APPLICATION FOR PERMIT
City or Town s/y" /,�i �`�' cr =Date:
UMBER
Date /�® �-4—
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In accordance with the pr/ovvisions of M.G.L. Chapter 148, as provided in Section application is hereby made
l by i` / 1,As d
(Full name of person,-Firm or Corporation)
Address �"�`� G`c- Cv rtie�io w,
(Street or P.O.Box)(City or Town)
For permission to (state clearly purpose for which permit is requested) H S' �/ AC--t''14 U
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Name.of competent operator (If Applicable) � Nam✓ �l Cert. No.
Date Issued-rejected By
(Signature of Applicant)
Date of expiration Fee $ Paid Due
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PERMIT
City or Town D]G SAFE NUMBER
Date �b � t"�
:,StartDate: '
Permit Number (if applicable)
In accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
/to
0/5
(Full name at person,Firm or corporation)
for
Restrictions:
at "',T o�t�� , c ems/Ocs a �✓
(Give location by street and no.,or describe in such manner as to provide adequate identification of location) .
Fee Paid $ ---- - This Permit will expire on V/°lyrr' nJ2 7 I`-17
Signature of,Official Granting'Permit Title �—
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