24 MASON ST - BUILDING INSPECTION f � 3l �oa
C� C1 eoaoer— Pe
-PL-*RS1p{IST-BE ffUEG ArNO APPROVED BY T*IE
,LUSpIXTDR p8WR Tp A.PERWT$,SING GRANTED
`\\ \/\ C\ CITY OF SALEM
No, 1 )V J nor :
a
� "� Date J
!n b: A
s
Is Property Located in Location of r J
the Historic District? Yes_No_ Building q a �kol
Is Property Located in
the Conservation Area? Yes_No—
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Incta_ a Sidinn Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name � 5w
Address & Phone YY))97 n ✓Ii .33
Architect's Name ., /� 2
a t Address & Phone
Mechanics Name
Address & Phone
What is the purpose of building?
Material of building? IA ItQn�Q If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost �Clty License# N A state License #
Rome Improvement
c Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTIO
,�N
� OF WORK TO BE DONE �f
MAIL PERMIT TO: /`(o"e 4.AeP2
No.
APPLICATION FOR
PERMIT TO
{` LOCATION
nrA
PERMIT GRANTED
AP 7ROV�D
�✓
INSPECTOR BUILDINGS
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