98 Margin Street 2L Certificate of Fitness Application 5-7-2020 EA INIASSACT-TUSETTS
CITY OF SAL 1i
ICtMfiEKI.FYDRISC.()I_i F.;x 9-8 ^4;;-0343
FIE U-T€i A( NT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
'?vffNIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION'
FEE:$50.00 )
PROPERTY LOCATED AT -5, a UNIT# f--
IS TIIIS UNIT DISIGNATED AS G ONT OR BACK PLEASE CIRCLE ONE
OWNEWLESSER f ll S'�, I"[a MANAGER/AGENT
NO P.O.BOX
ADDRESS I ? vh:�C� ADDRESS
CITY,STATE,ZIP �� J / 1 11-7 CITY,STATE,zip l�1�1 I
RESIDENCE PHONE �/ T � - _ BUSINESS PHONE(24HRS) A,
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: I. LP 2. J)C-� 3. 4. 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE L5:Ut, ;3Wb
Inspectors use only
Date on initial inspection: 7 'o _ Date of reinspecti on: .
Date of issuance of certificate:.. .__ _ Date fee paid: 5/f A 0
Type of unit: Dwellin Other Check# 6,p q Check date: J� , .p
Notes:
Code Enforcement Inspector