39 NORTHEND AVE - BUILDING INSPECTION '"3016101WIlE fl A"M APPROVED 6Y jW
=P==PWR W A PERW B,EWO GRANTED
CITY OF_SALEM
No.
Wald
ZW*V DWW
IM FYporic Dhdr ?h Yu No ✓ Loeatioa of /
DaUdift Cem -e
s -
:- Am*? Y«No ✓
Permit to: BUILDING PERM FOR:
APPLICATION FO
(Circle whichever apply) Remof, InsWI Siding, Construct Deck, Shed, Pool,
iNReplaoa, Other.
PLEASE FILL OUT LE0IBLY A COMPLETELY TO AVOID DELAYS W PROCESSIM
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accortLig.to the folkR*V
spedficaWns:
Owner's Name
Address 6 Phan .�- iv�SY`fh c� �[/ ,��w 2f 'SS/�_
Architect's Name
Address d Phone
Mechanics Name
Address & Phone f 1
Who istopgm"ar
mat w a taiYdrp4 M a ok,al for Ww.9mmy httias ?
Wa��0 C ft.. to mw� A�{? /I4
ES cpy Ua r 8Wa tJonna r
Bar I�rosusat „
Lic, f
Sig i t Applicant
THE PENALTY.
OF PERJURY
DESCRWTION OF WORK M BE DONE /
aD7 Dili �fG/ OT
6a
MAIL PERMIT Tfx ,39 /�/v �r �wc �u� n/1 0/17
No-\�--
APPLICATION FOR
PERIwT TO
LOCATION
MI Gill
�\ANTED
19
V�D ,
NSPECT OF BUILDINGS