211 NORTH STREET - BUILDING INSPECTION 211 NORTH STREET
CITY OF SALEM
DEPARTMENT OF PUBLIC SERVICES
REQUEST FOR CURB CUT
41
DATE OF REQUEST:
REQUESTED BYPHONE:-7`l`
LOCATION (as speci c as possible):
LENGTH OF CUT:.
•` / ._�(r C� tom+..'-( - `�'_�
INVOICE TO:
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FOR OFFICE USE ONLY
AMOUNT DUE: $8.00 PER FOOT X FEET = $
APPROVED BY: BLDG. INSPECTOR
-DEPT. OF PUBLIC CFR Vlf FS
NOT APPROVED: tee/ a DEPT.: � L/�i� • �-�--
EXPLANATION:
DATE OF INVOICE:
PAYMENT RECEIVED: