18 NICHOLS - BUILDING INSPECTION 'l m�:1`� �1� v n:" °�'1•�"i'Ye; tt _,'`F J, ! r.a t r?:"..F�'� !. ','�ti
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DATE: )l
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3 PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR 10 A PERMIT BEING GRANTED
Location of Building !� ItIi/fGf1aL
'33 Building Permit:ApplicationFor:
'(Circle whichever applies) Roof, Reroof, Install Siding, Construct Deck, Shed,Pool
Addition, Alteration, RepairrReplace,Foundation Only, Wrecking
Other. t
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOW DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies for a permit to
build according to the following specifications:
OwneriName: lf'}R2. f dimaLes V� Contractor:
Street I2 N OYOL5 bj q City 5,4/� Street City
State Al�1 Phone (608 ! F32— 909 I State Phone( )
Architect: ��D e City of Salem Lie#
Street City State Lie# HIP#
State Phone ( ) Homeowners Exempt Form_y/ es no
Structure: (please circle),Single Family, Multi Family# Other
Estimated Cost of job S 3 S so Lo
Will building confirm to 1 ? yes no
Asbestos?_yea_ono
Description of work to be done: / e-lgrz odw-v t X/5 771//J ff0�+6�
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Drawings Submitted:__Sri no Mail Permit to: ,��/���� �/ �����/�S OmZ3
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Signature of Application,SIGNED UNDER THE PENALTY OF PERJURY
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CONSTRUCTION TO B&COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
Department use only: Perron'# Zoning Map/Lot
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Permit fee S
COMMMS: