ANTIQUES AT 285 DERBY ro
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Permit Number
PERMIT MUST BE OBTAINED BEFORE 5EGINNING WORK
APPLICATION MUST BE SUBMITTED IN DUPLICATE, CNE SET TO BE FILED WITH THE
PLANNING DEPARTMENT, AND ONE SET (REARLUG THE APPROVAL OF THE PLANNING
DEPARTMENT) TO BE FILED WITH THE BUILDING INSPECTOR.
COYp,j
Location, Ownership, and Detail Must be Correct, Complete
s and Legible. Separata Application Required for Every Sign.
mn ooApplication for Permit to Erect a Sign
Salem, Massachusetts
19
TO THE BIULDI'1G I:iSPECTOR:
The undersicne: .` ✓
.ereby applies for a pernit to Erect,
a sign on the following described building: — _ Alter, _ Repai
Location and No. Woning/District
Name of Property Owner
Name of Sign Owner
Address
If Owner is a corporate body name of responsible officer
Name of Licensed Sign Erector A4
Address Salem
License No.
Use of Building: 1st Floor 3rd Floor
2nd Floor 4th Floor
Type of Sign: Surface, _ Right Angles to Building, _ Free Standing
Other (specify) Height:
Sign Materials �—cC,
Sign Dimensions Sign Area
S:
Existing Signs: Surface: Sign Area
Right Angles: SF
Sign Area
Free-Standing Sign Area SF-
Other Sr
Sign Area SF
Signs to be Removed: Type de1 pA � Sign Area may¢ �
Frontage: Building FT Property p y FT
Signature of Owne r� L � �J
Signature of Owners AuChoriz d Representative
Address
Estimated Cost
of New Work Telephone
APPROVALS: Signature of Property ower
CGL/! i�^ ^,
Salem P anning Depar nt Super intenoent or c•.:ets istorica ommjssion
ON REVERSE PLEASE SHOW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND
BUILDING ENTRANCE.
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ANTIQUES AT 285 DERBY ST
SALEM, MA. 01970 118
5.174/1 0
19PAY
TO THE
ORDER
9F 'OM1./! __(\Y �-�//'�--� s
DOLLARS B'�m
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