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. Go hp Tonttttottlttrttlth of magrittrhuurtto <br /> APPLICATION FOR PERMIT <br /> No. 19 <br /> TO THE LICENSING AUTHOffiTIES: (Date) <br /> In accordance with the provisions of the Statutes relating thereto, application for a Permit is <br /> hereby made by <br /> Name C J-IPP' 6;Y <br /> (Full name of person.firm or corporation makingapplication) <br /> to (2FI-W 761 T/3k( S'ER✓iclr <br /> 1 <br /> Z WOiJLD L !//L'— j.0. (JS'e ,� MOI %G Lf F'HCnre+� <br /> State clearly /- O C AT d>� /,v %>-IfT Oz ar <br /> purpose for (2'(2 1; U P P!9 ASI &WC ">✓ ni✓ /2G-Cj u���— Fn ,� <br /> which permit V'?a1o2Ur e!�OC9 rre <br /> is requested. <br /> I <br /> I <br /> y�lc/`tcl� /tea T/J7i3G1T'L/jNc�' �G'iV� _ <br /> (Give location by street and number) <br /> • G <br /> n '0� � (Signature of applicant) � <br /> Permit issued m FFc I "aa�aa) <br /> FORM 1058 HOBBS A FIG!1`IIBUSH BOSTON <br /> RtyU1qE,Nr <br /> OF),/Cr <br /> d <br /> • <br />