101 LORING AVE_ CRUSTTOWN ROUTING SLIP 4-17-25 CITY OF SALEM,MASSACHUSETTS
LICENSING BOARD
93 WASH NGTON STREET 2M FLOOR
` �- i a SALEM,MA 01970 GARY M.BARREIT,CHAIRMAN
r. TEL.978-745-9595 EXT.41504 DEBORAH GREEL
mmojica@Saiemcom GARY SANTO,JR
DOMINICK PANGALLO SGr.MICE BALL,SPEC.INV.
MAYOR MEllSSA MOJICA,
CLERK OF THE BOARD
ROUTING SLIP
The Salem Licensing Board requires each applicant to have the appropriate Departments sign this
Routing Slip and return it to the Licensing Board Office prior to the issuance of a license.
BUSINESS: n
Corporate Name: P Lf �-
D/B/A: nn /lic, 1M
LOCATION: D - L(�f�t �i )°t V C . Tele. # / 7 ) -,7� 7 6 goo
TYPE OF LICENSE: , Y 0. 2 /Y ?79-c;2oZ 4!,2,9617
APPLICANTS NAME: 'K A F t'�`G A�41YIAIL: V
Residence p� j �/✓t'��
Street: S - )J f K\vHome tel1ephone#ygl c/L)�,o " La '
City: 1 l State:a--1- Zip: ( 1 S3 D
'**TO ALL CITY DEPARTMENTS: By signing this slip you are only acknowledging that the
applicant has made your department aware of their plans for the above listed business.
Applicants will not be issued a license until each Department has confirmed that all
requirements have been met. **
W+ >•
aL4r,P `t(t
fSalem Hi oric Commission DATE J Sign/RevlewLanning Dept. DATE
98Was ton Street -2nd Flr. 9 s teet-2nd Fir.
� )7 �S �- L I 2 r
faleni Hea partment DATE FI reve ion D/ E
98 Washington Street -3'd Fir. 2G.Es nde(9 B-745-7777) h.a
r�c as a� wa IZ�
B Iding Inspector DAME
98 Washington Sit -2nd Flr. (Water ept.)98 Washington Street—2nd Fir.
Collector's Office DATE
93 Washington Street— 11 Fir.