HomeMy WebLinkAboutMiscellaneous - 39 MAIN STREET 4/30/2018 (2) _ No. Andover Restaurant (golfs) _
39 Main St Expires December
TOWN OF NORTH ANDOVER
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BOARD OF HEALTH
27 CHARLES STREET ' — 9 2002
NORTH ANDOVER, MA 01845
TELEPHONE # (978) 688-9540 L " --
TOBACCO SALES PERMIT APPLICATION
Date:
Establishment Name: fi Nil U orw -b6d Ur
Business Address: 39 ftinSiPAndUtr
Mailing Address (if different):
Telephone: 91% Q( 3 q3 LZ
Applicant's Name & Title-LtNiw
Applicant's Address: t W W mu i�-, W fi UVff IV a Lffq")
Owner of Establishment (if different):
Corporation Name: MOY411 61I1WVLZ b�a
Corporation Address: /
Emergency Response Person: (,(
Telephone: Business: C2-7 I Z
Revision: 8/5/98
Enclosure
Fee: $20.00 Made payable to the Town of North Andover
A late fee was implemented by The Board of Health, if you do not renew by jory,1 the
fee will be $40.00. I (O�