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mSPEGIOB PRIOR MDA.PEAWT UWa GRANTED
CITY OF_SALEM
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof. Reroof, Install SWN Construct Deck, Shed, Pool,
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PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The ur Waigned twoW applies for a pom* to build according to the following
Owner's Nano
Address a Phone (6 02 Le W s D .G lI 1 wo- v 6 a
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Architect's Name
Address A Phone f I
Mechanics Name
Address 6 Phone f I
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Swat* of Applicant
SMED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE r
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MAIL PERMITTO", 5��40Z L¢wa 0 rG Defoe, 41, �GsS 4/9oG
No.
APPLICATION FOR
® PE/RANT TO
LOCATION
PERMIT GRANTED
2.0
INSPECTOR OF BUILDINGS