DERBY SQ RESTAURANT 133 Washington Street
Derby Sq, Restaurant v
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PL N.I I i _- -
SE- TO SE F1LEp 1JITH T;,
?PLIC',TI01J JST1L— _' .I GF is-E FL.',J:NII:G
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_ -,ers- - aii .orrect , Cc oiete
Cn and F�cuired 1-3r C Every
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pplicaLion for =�fll ,
Salem, .zsszc;,usetts��-19 7
' J
TO TrE DUILDING I :;SPECTOR: /
_r-b applies for a perr..it to V `Erect, _ Alter , Repair
-�.e foilc.dino described buildicc :
sicn cn Z _
onina/District
Location and IJo.
';are of Property Owner i
K T
ame of Sign Owne r
If Owner is a corporate body nz-e of responsible officer
%ame of Licensed Sign Erector r1rpe-
_ Salem
i cense No
Address S
st Floor_ 3rd Floor
1
Use of Building: � 4th Floor
Znd Floor crf
Richt ncinc , Free Standing ,
Type of Sian: C�Surface, Ales to Euild
� '
Height:
Other (specify)
Slgn Y.aterials. L,Jo
�
Sion Area ol-y SF
Sien Dimensions �� �� _ 7dO
SF
Sign Area
Existing Sions : Surface: Sign Area SF
Richt Angles: Sign Area SF
Free-Standing Sion Area SF
Other
Sian Area SF
Signs to be Removed: Type
FT Property FT
Frontage: Building
Name and Address of Signature of Owner
insurance Compan.Y
Signature of Owners Authorized Representative
Address
Estimated Cost7� i' � a$2
of Jiew '.:ork � .� pI1
APPRO LS• - Signature of Property
Owner �� ✓` ��� rTu"'
f �2u5
� • 7rnriraI l.or'nI sior
CHARLES D. ALEX
1822
MARIA N. ALEX
13 HAMERICK ROAD
W. PEABODY, MA 19/"� 53-7163
` 2113
1 PAY TO THE
ORDER OF d-- $
,c
DOLLARS
The rren Five
G: MASSACHUSETTS
PEABODV,MASSOCHUSETi50196D
FOR
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