125 NORTH ST - BUILDING INSPECTION , I
APPLICATION FOR
PERRY TO
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PERMIT GRANTED
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APPROVED
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CITY OF SALEM
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Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Root, Remof, Instal Siding, Construct Decit, Shred, Pool,
it Other.
PLEASE FILL OUT LEGIBLY a COMPLETELY TO AVOID DELAYS MI PROCESSMq
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies fora permit to build aocordwig.to the following
specifications: /
Owners Name 12' ✓G c2910'V _ jlf--iyN4rH &f-CHf,,A�
Address A Phone �3 ( ?7 ej- 6 b y -a y y r
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Architect's Name
Address a Phone ( )
Mechanics Name
Address & Phone ( 1
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Signature or Applicant
SONED UNDER THE PENALTY'
DESCRIPTION OF WORK TO BE DONE of PERJURY
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MAIL,PERMIT TO: �3 SNAM'S l��a ,� ►QO. Q 2�,(�2r , �'1A, a1 frz l