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APPLICATION FOR PERMIT
City or Town:
Date:
permit Number: 101346
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 18 Avery Ln /South Yarmouth, MA 02664
09/to/2oa3
For permission to: lnstall Fire Alarm System (RESIDENTIAL)s27CMR10:03
Name of Competent Operator ADT
Date lssued-Rejecled 09 /LO / 20L3 By
Date of Expiration . LL / 29 / 2OL3
Cert. No
Fee: 5s0.00 $ paid
GEnature of applfcanif
Due
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