77 MASON ST - BUILDING INSPECTION (2) fL `MWTOE fRMW* G APPROVEfl BY TW
212PFCItlt.1 PWR TO A PERMIT BEING GRAND
CITY OF_SALEM
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i
�Y+ire Ward
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Is Property Locabd In Location of
the Hist do Dweict? Yda No_ sodding 77IV0.So rJ .
Is ProP"tocatad In V '
: - NN Cormenradon Area? Ysq__No_
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: Sn*e r..r (�erova�ie�S
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSMG
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accordNig,to the following
Specifications:
Owners Name 2; W k [—rr re rorl3zs L L(—
e
Address & Phone 2 x�6r.:& W MarS(L (78/) 631- oSY 6
Architect's Name Fjgb- kt-Qk 'A-e4S
Address & Phone IsgAL_nz ReKIA C-sse,<-. Mrs
Mechanics Name /:: 2-'cc 1 n C
Address & Phone Po (3eK 39 A.Lr9c (978) ,23 S - Y S/y
Wirt Is to pgme at bWkNng7` Cd nCL na�. ..a^
MdWW of tatlldptp? a N a dwawq,for Crow mmy famaes? i
WIN talJldlnq cmft m to law? A S Asbestos? Al 0
EatlnWad coat)f3 S oe c y umme• stag uterine a 6 9
an•a Improvement
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Signature of AWicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
_Sn�cmrft (Lent.r<.Ran
I VJ-eArad Conko
MAIL PERMIT TO: C .
Pa 13ok 39
NoiL"\ -6S
APPLICATION FOR j•�
PERM TO
LOCATION I
PERMIT GRANTED
19
AP7VfD
INSPECTOO OF BUILDINGS