179 OCEAN AVE W - BUILDING INSPECTION +Li1MSj"SZ.BEfiL£fakND 11?PROVfD 8Y T44E
,Ipl$,pZCIjB ,PRIDR TD A PERMIT f3fMG GRANTED
CITY OF SALEM
r
No. Date 77 d
Is Property Located In Location of
the Historic District? Yes_No_ Build ing
is Property Located In
the Conserntlon Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidi, Construgt Deck, Shed, P I,
Repair/Repiace, Other: ep% YR,,e— �
lzlk—
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
e4 �f
Address & Phone /7c/ (fie ti �.�_ _
Architect's Name
Address & Phone L
Mechanics Name
Address & Phone f
What Is the purpose of building?
Material of tRrllding? 4 )aad If a dwelling,for tow many families?
Will bdkmng conform to law? Asbestos?
EsUmeted coat GGG' city License 022 A state License r
Rome Improvement x
Lie. I /1 Signature of icant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
1�4`/ `"/f— s:/.V-i?,
MAIL PERMITTO: �,/ (/Cell l7`fL2� C(J2J
No.
APPLICATION FOR
PERMIT TO
LOCATION. j
PERMIT GRANTED
AP ROV�D
INSPECT.INSPECTOA OF BUILDINGS