1 BERUBE ROAD - BUILDING JACKET 1 BERUBE ROAD
CITY OF SALEM
DEPARTMENT OF PUBLIC SERVICES
REQUEST FOR CURB CUT
DATE OF REQUEST: /111 & c29 - l t 9 G
REQUESTED BY: �-D RY131 e /<'/ PHONE: 7
LOCATION (as specific as possible): 7�/ �F ORo rCo,?A,,,,. a Wn4L 5
C ri \AALL ST S - t9 -rqE Fun o iv
LENGTH OF CUT: ®99'PX -5- f7-
INVOICE
te?INVOICE TO: L /AID 09 VV q/'Tr_
Pe. QLreS�RV,,4F_ s
Q/YE . Gee P F u
FOR OFFICE USE ONLY
AMOUNT DUE: $8.00 PER FOOT X FEET = $
APPROVED BY: BLDG. WSPECTOR ��
DEPT. C F PUBLIC SERVICES
NOT APPROVED: DEPT.:
EXPLANATION:
DATE OF INVOICE:
PAYMENT RECEIVED: