61 MEMORIAL DR - BUILDING INSPECTION (2) qPLIMIANSTISE fWA94N9 APPROVED BY 744E
=PIC=PWR W A PIsR W f3LING GRANTED
CITY OF_SALEM
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Location of
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Is Pmpany LoceM in
: ft Caarwalon Am.? Yu NO v
Permit to: BUILDING PERMIT APPLICATION FOR:
(Clmle whichever apply) Roof, Retool. Install Siding, Construct Deck, Shed, Pool,
Rspair/Replac:e, Other.
PLEASE FILL OUT LEMLY i COMPLETELY TO AVOID DELAYS IN PROCESSM
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build aocorcLig.to the following
specifications:
Owner's Name 11 t0Eah`/
Address r!< Phone L l Memo\mM-t , (qi&) 14 5 - L L L
Architect's Name `o C
Address & Phon@�VktNaS�6ry 9-
Mechanics Name
Address A Phone ( )
What Is to p.pm of b~
MOWN a W~ V toy 1 S t y% a n a dwaffrq,for now nary famau9 I
We' aaMorm to I.rrt �) 2 S Av0ulm? N
Erinnr.d Cod �)- Say.„o ply uk a sfw umm N
ass. L*toe,.at o
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Signature of Apoicant
SKMIED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAUL PERMIT M.
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CITY OF SALEM
BVIImIIdG DEPARTMM
HOMEOWNER UCENSE EKEwnow
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HOWEOW14M 91 14 5� L
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PRES�NrpCALWV ADDABS: -
7be emreat,000 d'�D11eo`r°ai'.va.eoocnded to b�dndmd*sAip 'C.IIO
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�.ysovieed tba>�e,,.as'.et as apet,rb.a •
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a bom,cowaa Sseh 9wmwwner' chaff sua I to the Bwldbg aseda rise boildtq pet10*
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The Wdosiprd'lamoownd ardfms that he/she mdatvy&the CIV of Salem Bdlmoi Depaoas*.
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HOMEOWM*S 51GNA717RL
APPROVAL OF B=ING VVECTCR
Sm aba sidc for same Gods
HOMEOWNER'S EXEMP'I•ION
TAc code sum tint •my b=weowm perfcrm%S pvA for whkb a boaft perm$is aegabsd absS iK
exempt from the provisions oflhb ucdm(Scale]op.U.2icensiaS ati ComenxUm Sopa vim
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at,apavye,L•
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supervim(sot A ppeodla Q.Rulra sad Reiulatiow for l.TecosioS Coastrsicdm Sapenbosa•Saediasr
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liecnud S»povbw. 7be bomeawwa snug as mpervb.w Y raWasose >Rsjoosl6lb. .
To cnnnc that do homeowner b fully mote of M&a repaaelbUhles,mmq aommmides req�ir 6 a ris
of an permil applkmkr4 that dx bomoowna oadti*A bLWw mrderasods the sespmsibmn at*
supavbm You mq canto arrrcad and Wape musts a t mkcnVAsdm to aas in ym eommmd*