191 LAFAYETTE STREET - SIGN PERMIT 191 Lafayette Street
Berube & Sons Funeral Home
Permit Number
PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK
APPLICATION MUST BE SUBMITTED IN DUPLICATE, ONE SET TO BE FILED WITH THE PLANNING
DEPARTMENT, AND ONE SET (BEARING THE APPROVAL OF THE PLANNING DEPARTMENT) TO BE
FILED WITH THE BUILDING INSPECTOR.
`OND1 Location, Ownership and Detail Must be Correct, Complete and Legible. Separate
_ Application Required for Every Sign.
Application for Permit to Erect a Sig
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n I
Salem, Massachusetts A4 �� 19
TO THE BUILDING INSPECTOR:
The undersigned hereby applies for a permit to X Erect,_Alter,_Repair
a sign on the following described building:
Location and No. �" / Zoning/District
Name of Property Owner I Y}oma c Le- ibe
Name of Sign Owner =0-vll, s L js,-,
Address
If Owner is a corporate body, namr Leo e of responsible officer 11'1 Gwa5 L, r& )
L
Name of Licensed Sign Erector ori rriveo LAe A60.>
Geoie -A-
Address_ Lor"�c1 5t7,(-9,MSalem License No.
Use of Building: Ist Floor 3rd Floor
2nd Floor 4th Floor
Type of Sign: —Surface, _ Right Angles to Building, X Free Standing
Other (specify) Height:
Sign Materials __ Woo
Sign Dimensions Sign Area SF
Existing Signs: Surface: Sign Area SF
Right Angles: Sign Area SF
Free Standing: Sign Area SF
Other: Sign Area SF
Signs to be Removed: Type Sign Area SF
Frontage: Building FT Property FT
Signature of Owner—
Signature of Owner's Authorized Representative
AddressL(7+ck IIS f so n
Estimated Cost 2 �O Telephone d �Y� �yL�- "7f
of New Work $ J
Signature of Property Owner -
APPROVALS:
Salem Planning Departm t Superintendent of Streets Historical Commission
ON REVERSE SIDE PLEASE SHOW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND BUILDING
L ENTRANCE.
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BERUBE & SONS FUNERAL HOME, INC.
EXPLANATION
191 LAFA(ETTE STREET PH.978-74Amouwr
PAY SALEM,MA 01970 4.2177 �` (, Z 16317
AMOUNT 00
OF -
DATE 5-13-110
l+ � TO THE OgOEq OF
'-t DOLLARS
DESGgIprIDN C, AMOUNT
111011
NUMBER
q3j.i 1
FLEET .....,„m.
55473 SALEM CENTER OFFICE SALEM,MA 01970
'0 16 3 1 7n•
1:0 & 10001381:
:0 1 100
O i 38�: 021,
8 58 2 7119