50 Broadway completed routing slip CITY OF SALEM,MASSACHUSETTS
LICENSING BOARD
I� 93 WASH NGTON STREET 2nd FLOOR
SALEM,MA 01970 ROBERT M ST.PIERRE,CHAIRMAN
TEL.978-745-9595 EXT.5631 PAUL FLORES
FAX 978-744-1279 DEBORAH GREEL
IQMBERLEY DRISCOLL
MAYOR MF.I.T94A PAP AR.O.
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 NAME /�
Corporate name: E- A � &� � l 1� �'^-'tl �'`'
LOCATION: Tele. #'Wd In— U
LTYPE OF LICENSE: Z'
APPLICANTS NAME: V, +
Residence
Street: vie, Home telephone#
City: aQlvg,,v t- State/'l/A— zip: 'fit
***TO ALL CITY DEPARTMENTS: By signing this slip you are only acknowledging that the
applicant has made your department aware of their plans. Licenses will not be issued a
license until all Departments have confirmed that the applicant has complied with all
requests.*** _ ^^
WSaleHistoric Com ission DATE Sign/Rev Planning Dept. DATE
n Str t 98 W in t treet
Z
2Department AT ire Nevention DATE
98 Washir tree4 29 Fort Avenue
ZOL d/)2/)O 64'1j�4V aA--
Building Inspector DATE be t. of Public Services DATE
98 Washington Street (Water Dept.) 98 Washington Street