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41TtS-MUST-BEfiLfD-ANG APPROVED BY T*IE
. WpXTDR ,PWR TD A.PERMIT BEING GRANTED
CITY OF SALEM
No. \� J >. "� Date
NINB
Is Property Located in Location of
the Historic District? Yes_No_ Building
Is Property Located in
the conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Reef Reno Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name tzame.5
Address & Phone ll Gd� S�. (M) 7Y!-ly/f
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone 1 )
What is the purpose of building? X Ic4
Material of building? Fns, 4 If a dwelling, for how many families?
Will building conform to law? Y Asbestos?
Estimated cost City License n N P' State License a
Home Improvement
Lie. ak
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: f� �lb� 57' / " ' )el�'�"
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No�
APPLICATION FOR
PERMIT TO
LOCATION c
A\
PERMIT GRANTED
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AP OV�D
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