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Please print 3 copies et for Fire Permit Application
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Associated Building Permit # Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name 1 # Units L
2. Description of Work
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Extg Sq Ft � J New/Added Sq Ft � Total Sq Ft
Valuation $
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L7New ❑ Add ❑ Alter ❑ Demo
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last First�—
Owner's Address Owner's E-mail Address ..._
City State Zip 1 Telephoned
❑ 4. Architect/Designer's Name LastFirst til Lic. No. F
ArchitecUDesigner's Address - Architect/Designer's EE-(mail—Address ���•��JJJ
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City ✓/�. Vr`FC State %�— Zip l ®' Telephone /( v O _o (�
❑ 5. Engineer's Name Last �— v--� First F7_7_ Lic. No.
Engineer's Address - Engineer's E-mail Address
City _ State L, Zip17, TelephoneC-
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❑ 6. Contractor's Name Lasti ✓Z'�V V l Gt �' Fifa Lic. No. PRIDE Mass l �l
Contractor's Address ✓� �` Contractor's E-mail Adgress
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City �I. State r Zip Telephone f/ j
OFFICE USE ONLY j PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP
1 U PLAN CHECK FEE $
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