13 NICHOLS ST - BUILDING INSPECTION -V w * IlST,9EfKM4AD APPROVEfl BY AGE
Jpl,t,p—QB PRIOR TDA.PEBWT UWR GRANTED
CITY OF_SALEM
is Pmpo,tt,Lo=m in Loeacim of C3 ,�,��olh S�-
n.fwfmtc t)twfat? YM No� a.uais
is AopMy Loomm in
a»Cawnwton Aim? Yos No
BUILDING PERMIT APPLICATION FOR:
Permit to:
((Circle whichever apply) Roof, Remd, Install SWN, C,Pr►suuct Dock. Shed. Ppol.
Rspawfileplece. Other•. 9 fe Cl'A
PLEASE haul OUT LEGIBLY i COMPLETELY TO AVOID DELAYS N PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specillcadom-
Owner's Name (�=� `� �a R ��
Address 6 Phone
Archkeds Name
Address & Phone J f )
Medhanics Name
Address a Phone f )
wrw is fr PAPm of txriakp? •'�' Gl�z ��
f "m a f■rtarp? M a*me&q,for now many twaim?
vm O A*v mdm to low? Mb""?
EaWaWd ooN tJ `� C1W ww"r N A LIoMw•
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sow Ia�ro.�.■e .l Lie. 0�— � m of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRW WN OF WORK TO BE DONE
MAIL PERMIT TO;
No. /DlD—Dl
s
APPLICATION FOR
PERMIT TO
,(� /
LOCATION
3 �/ �tiols S��Q � •
PERMIT GRANTED
IA6PWOW0F BUILDINGS
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Name
Aderem
( dy/State2ipe `� `P i Phone
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CRY or Towne PamlNlaw N
/tada{Aotlority(drds one):
1. Board of ftakk L Budding Departmest 3.Clly/r'owf Clerk 4.
6.Oekar >0tetrleal isrpeelor i llambing Inspector
Combs Pemst
F600a Me
Information and Instructs cnv%Ye&
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°�be FAM 0®is*4 paalk4ke =A=k any ocs yar°god°°ly b Ow"aII 1jjM"*�*5(db or
dA woA absdt mttdpk uadeT• Site Addtae"the aW�tboeld
at tows tsaY be provided 10 tfjs
polity m te�AOt bm beso®aft t 4M A n moribe mted ant ack
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p betiow a amaae�
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(Le.a doff liana of pwe0f b boA kava elr)raid Dtasoa and gma yaa bave any 4�pO01
Ts ofoa of lay.d pdom
WOW blte to thank yo0 is advaa•e for
yarns 000ptsatbs
pIMCdolot bc&MNdtseoeaaY.
The Depattmaaf t addttxb ockpbooe and ds atmtbtr: wt of Massacd= is
The DqwWlcdof b mbsWA
oils aI Invadpdo W
600 Washington Sitar
Boston.MA 02111
TeL 0 617-727-900 6 t 406 o 7749 7-MASSAFE
pavisad 5-2&05 w"mm.gov/dja
CITY OR SALUNg MAssACHUSKIrTs
PUBUC PROPtRTY OttAItTMtNT
120 W"MIM01011 STMtR, Us PUme
ULEW. MASSOA MUSarM 01070
TCLXPHGMM1 078-741E149e UT 340
PAM 170.740•N40
MISS
d�D�need Ferm
Is e000rdasca with the pmvlsioas of MQ,co 3
i3m'ldinS Permit is that the debrL � a cosd�tion of your
Offs a properly licensed solid waste' i dfs tide as de shall be disposed
�pter HL 3150 A. tacilig►as defined by MCiL
no debds will be disposed o!in:
�I
(i'.acados oiFacility)
SfMPUa tre of Applicant
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