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RECEIVED
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',e � 4l. BUILDING DEPARTMENT '3
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APPLICATION FOR FIRE PROTECTION PERMIT
Date PERMIT NUMBER _5 (-)-ova -DD 4- �S
Projected Start Date: 6 f7JA�---- Date of issue
In accordance with the provisions of 780 CMR and M.G.L. Chapter 148, as provided in
Section
This application is hereby made
by CI rr_E 4.14 rrxyv
l (Full name of person, Firm or Corporation)
Address 9( cM
�a� v,,a.-�'It—�(, ccd Hy.6,4,,v,`S .%Zn LT I ca 1
(Contact#) )t1, t'iwl Pree: ` Email iti ►r .,1"t4-Fe-; eo e,I,,s Ztt- , G01Z
Owner of property C tt,iOe_ cod,x v F I c,,-1-ablr--- Pct.;k f/
Job Location ,c /ts; /is 4)Str_/;w�5f POitc�r. .
(Street&City or Town)
For permission to (state clearly purpose for which permit is
requested) :rrvS te,,,i/ A,ty / L t, 5�1141 .5 iety 5_yi ( u.,11).1-�C thew l<<to e- v
bcco
Name of competent operator(if applicable)
Cert. or License No. -;"9 Estimated Cost of Construction: 'S?D-
By irfil: ,/
(Signifture ofApplicant)
Building Official:
s< l Date: G 30 'd.
FEE: $50.00
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