Gedarovich 5104080 PAF *k Permit Authorization
mass save Form
SamWa wood energy efR wncy
Site ID: 5104080 Customer: DAVID GEDAROVICH
owner of the property located at:
(Owner's Name,printed)
49 Washington Square Salem, MA 01970
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
Owner's Signature:
Date: 01 / 10 / 2024
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FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractorto the
above referenced project:
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 For office use Only
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