Fire Alarm Tttg of *Ulem, Asssac4usPits '
f FIRE DEPARTMENT-,FIRE PREVENTION BUREAU Fee D $10,00
i y 48 Lafayette Street Ck.# l `s
Salem, Massachusetts 01970 Rec'd by:
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APPLICATION FOR PERMIT
To: HEAD OF FIRE DEPARTMENT
In accordance with the provisions of the Mass. General Laws and/or the Salem Fire Code, application is hereby made for a permit to
install approved fire alarm devices. �'2`� 1416 f} 11fi1v_o /-tie"t� I?
Location: T/A 0�U r- 9 4( ( Owner: [ ` f C. 4 ►`��t
Installer: Cr �'n-4 �jI c-(r! Tel# ?
Installer's Address: 3 Clips e s_J S License.#
Type of Occupancy: n,f-•7 <
-LIST TYPE AND LOCATIONS OF DEVICES ON REVERSE SIDE, OR PROVIDE PLANS. -
Installation subject to final ins ction and filing of Certificate of Completion, installer. Irplailer must be present.
Date of approval:
> Q (Signature of Applicant)
Date of expiration:
(Address)
Form#81F(Rev.12/88) DO NOT WRITE BELOW THIS LINE
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