30 MASON ST - BUILDING INSPECTION e.
PtM 1lAtl6YeEfIL494AD APPROVED BY TW
JVAP=Wl PROR W A.PERMIT BEING GRANTED
\ CITY OF_SALEM
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Permit to:
BUILDING PERMIT APPLICATION FOR:
(Clrcie whichever apply) Roct,_Reroof Install Siding, Construct Dads, Shed, Pool,
iNRepla . Other.
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PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSM
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accorc6ig,to the following
specNleations:
Owner`s Name 1-7),tiA h &,-A cp l I ,a c
Address d Phone -) nM a c,,,. S+ (q?tj 3 t 7 3 -).s/
Architect's Name \
Address A Phone
Mechanics Name \
Address A Phone ( 1
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7 Signature of Applicant
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uNDER THE PENALTY,
DESCRIPTION F WORK TO BE DONE ,
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MAIL PERMIT TO: v0 1149 Al S�
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HOINEOWNER'S SIGNATURE
APPROVAL OF B=D4G D;SPEC!'0!t
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HOMEOWNER'S EXEWIIM-ON
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