2 BENTLEY STREET - BUILDING JACKET \,
B
ENTLY STREET
CITY OF SALEM
DEPARTMENT OF PUBLIC SERVICES
REQUEST FOR CURB CUT
DATE OF REQUEST:
REQUESTED BY:
_f;,,/L PHONE: /moi) �3 � 7iCi
_. .
_,_,-LOCATION (as-specific as possible):
LENGTH OF CUT:
COST PER FOOT: $8.00
INVOICE TO:
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FOR OFFICE USE ONLY
APPROVED BY: BLDG. INSPECTOR
DEPT. OF PUBLIC SERVICES
NOT APPROVED r DEPT.
EXPLANATION:
D E OF INVOICE:
PAYMENT RECEIVED: