100 MEMORIAL DR - BUILDING INSPECTION GI'+'1 YrO�PI.Y
�L1kN�'{pliSfi�£fiLf •APPRom BY T44E
II�I.S.PECJ.D�n .PWB TD.A_PERMIT BEING GRANTED
CITY OF SALEM
CYe -
LocationDate
No.
g/f70 of
13 ptopperty Located in �Rt:L'din^e ti "�� (%D�. ��--
the Historic District? Yes_ No
Is Property Located in
the Conservation Area? Yes_,No
BUILDING PERMIT APPLICATION FOR:
Permit to:
Construct Deck, Shed,
(Circle whichever apply) Roof, Reroof, Install Siding, Pool,
RepaidRepiace. 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:
Clwners Name _ II••
Address & Phone �®
0 a• a( Pr'
;I��• � b5
Architect's Name j
Address & Phone Gng
le
_
(/ Mechanics Name
Address & Phone
LO A,�/,/Rv�2y
What Is the Purpose of building? Onti 01
Material of building? �(�. rr e —If a dwelling,for how many families? __--
�WIII building conform to law? Asbestos?f
Estimated cost 2'e
city License
C j kq f(,l O A N. r,� L Hose Imnrovenenc o N �� _-
/1 LiB• # Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF JW�ORK TO BE DONE
( 541,
0 / J
0n 5/1, ( 7 �O �J� ✓O I // ev
////J111n f `�� (v• I .1 C /� 3/V
MAIL PERMIT TO:
"1
No.
APPLICATION FOR
/q PERMIT TO
�O'ticfe t oi-
LOCATION
PERMIT GRANTED
APPR FD
INSPECTOR O BUILDINGS