90 NORTH ST - BUILDING INSPECTION '1
APPLICATION FOR
PERI/f TO
U� 4 ( s /7^�,,,
,
LOCATION
45�9 1611A s
PERMIT GRANTED
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AP7fD
INSPECTOR OF BUILDINGS
1
fL*NS1M! 13EfRfi*4 ID APPROVED BY T4IE
MPECUIR POOR T11 A PERMT BEING GRANtr€D
CITY OF_SALEM
No. \ oa. 3 B S'
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Is p owtY Locmd in Lacat1cm (y No
D �g hcato,hc bldcl7 Yes of
rl
tlhs
Is PmpMtY LoaNd in
No C mmason Am? Ye No t,-
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Root, Rwoof, Install Sid Construct Deck, Shed, Pool,
Repair/Replace,
PLEASE RLL OUT LEGIBLY Ilk COMPLETELY TO AVOID DELAYS IN PROCESI9 M
TO THE INSPECTOR OF BUILDINGS. '•
The urKkn wd hereby applies for a permit to build accordG-p.to the followft
specifications:
Owner's Name ,� µ
Address A Phone ( I
Architect's Name
Address d Phone ( I
Mechanics Name
Address 6 Phone IG 92,0 7 yJ- - S15 J- 2.
who is m•p pm a WWW
Mftw of trrlanp4 wu o o� n.dwsllrq,for haw m"WmIlm?
wN Oul ft="'. to hm? M �i Asbsstos4
Ewhhhslsd aop 13,000, uo m umm o_e-stub ui • o
xmffe"�t
00 /6
ISOWuri of Applioa t
SNUM UNDER THE PENALTY
DESCRIPTION OF WORK TO BE DONE of PERruRY
,
■o
MAIL PERMIT
01�70