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NORTH ANDOVER BUILDING DEPARTMENT
400 Osgood Street
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Tel: 978-688-9545
Fax: 978-688-9542
BUSINESS FORM FOR TOWN CLERK
DATE: 3//S ` o j—
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NAME: Pct-�erfej
ADDRESS: !L/ LY g n /Z- a(
ZONING DISTRICT:
TYPE OF BUSINESS: 411 Cf 4�h )4el'A t�
BUILDING LAYOUT PROVIDED: YES NO
AVAILABLE PARKING SPACES:
ZONING BY LAW USAGE: YES NO
BUILDING INSPECTOR SIGNATURE
Revised 11.5.04
WMESS FORM FOR TOWN CLERK