Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
266 Washington Street Certificate of Fitness Application 5-7-2020
vw cw�v.icr rv.tt ' it V�'rJV�.Pa�� � "•—� ��_ �— V CITY OF SAIFTvT:, MA SSACHUSETrS a �e�y��'rp j�Bo—.\i11*D hi.Jl'I4F uz }i 71 Pump, } p . TES...(978)741_1800 KMOI IrEY DRISCOLL MAYOR fBt W,4S cC/,s.�J DAVED Gx�-SAUK MAY 11.2020 d fiCt'iNG HEcit.�-I11Gfiiti3T ,�/7�� __ CITY OF SALEM BOARD OF HEALTH J G Application for Ca cafe of Inf ww IM ACMMAN(M V=STATE&QUARY CODE,aWM 11,105 CMR 410.000 STAMAPJDS OF FITNESS FOR HUM"I ITATIOK" WPUL- YYLOCATM AT G k171 4,L,4 S�e 3 P.O.BOX :)DP,BSSL 0 6 y< �/ �`� ADDUSS- ZIP -S PHONE_ MWESS PHONF- )TAL NUACM OF ROOMS: __ 9. IRE IS A FFTY($50)DOMAR M PAYABLE BY CHKK OR MONEY ORDER TO THE COY OF SALEM 3ARU.OFFMALTETMS FEE 1B PAY'.ABLE AT T E TIl&OF r ECTI N '1�I,IGA 'S BICvItIAT1JR _ --BATE 4---" Z 0 jUW2q=wegrA to cm inial iupwdow'._.r_--_—_ _ Daft©franspectiow .fe ofjwmace of sate: Date fee paid- - pi�afwontr Otc--- Cl #-�Cl2�I�date: tom:_- —_-- - - ----- -------- 3o Ettahmpedor 2014-06-272121 M7450343 Pagel