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16 OCEAN AVE - BUILDING INSPECTION (2) qpWmlA"w�Kq%dNpdm AVPMVGD By "a MnPRCZ9 PWR m A`1.MW ARNG GRANft CITY OF SALEM Dab wrd ZW"/oAmd Is PIGWIV LocaNd in N.mkbft r,- fl ', YM No ✓ f of !6 QC24 f�i e M Plapwry L000lod In r 10 aanUrAO 1 AM? Yoh No Psmrk to: 91ALDNl M PE W APPLJCATM POIL; (Ci lis,W* wer apply) Roof Rsmof InsWl SM4 Co WW Do* Shed, Pool, RApaldRsplsoa, 011ler:�1 i em 7�1 o I K;,-l-Qn r o o,,.. PI.UM PLL.OUT LMLY It OOIAPUM LY TO AVOW M AVS N PVACY TO THE INSPECTOR OF BUILDINGS: The urdwWwod hereby apples for a pormk to buN aomor&ig to dw_falowirrp speoftwom- Owners Name O l l Zy ri Address A Phom (�o ©ems u n Malik s Nnme -b, Address A Phone Msohanlos Name Address A Plxx ( 1 woYtrpip=arwomw ww a kdmmv N.drr.w�tornow sargr �--�— WE krr"oodam to low? (-) o r ie. I avokm of MOWN Ul am- Tw PENALTY' OP POIJUIIIr DUCK l NM OF VM011LC TO U D= MAIL PERMIT Tf? 6 ems abo J-e .� • ..�., .'e��s. r . . -- � � � �. ' .�. � � � �� `� 01 qr \� U o O s' � Q � � � � PuaUC PROPERTYD9PARTMWff 120 WASHIK6TDN STRaaT. aRD FL0*lt 5AL M,ItA0e97O TaL.(978)745-MOS UT.300 FAX (570)74040" MAYON DISPOSAL tF DE=AFFIDAVIT In aomdnm wi*ft PanVWM ofMM c 4%SK I aaimowb*&W as a o a"= off i ft Fem k N .aII debris mob"Am the cm tru"activity ®ovemed by this Bmlft Pem b"be disposed of in a plopady H mom aoH&Ws to haft,as ddbmd by MUL c 13L Si5ft The debris w'n be disposed of* 0 0 r--4--� Sl -O rr(Z, O cA r-A-;n Zj Looadm ofFwMW q �iJ QQA�-f N r�cJ L -3 vI d� Swu me ofPasmtt AppHeast Darr FULLY MZASB PPRRII�iT CLL4►RLT) msom>adoo . �oll � en . w�ctu;� G.�n-•� Name afPa®it AppHaot Fnm Namst if=y -Addrask City&States Mw above statute requires that debris from the demolition,MoVsho",rrhab or wha skaadon o �� Lcility as daSn blQ,cIQ S -V&and the buJUM pemitl or Hcmw m to indicate the bca0w of the f dit. f }� CITY OF SAlEM BXMMINGDEPAR' WU liONBOWM LICENSE E MaMON pkm Pd+ • DATB � �`� �� ' >OB LOCATION l(o `��e can ADDREM TELEPHONE PRESENT mAIIA?O ADDRESIi C J� c ✓, •rh Tha cwrug.cum}Hai cf'homeo"CW was CXmK m bdodt owner emi .8s'�OO stt=� 6 Umiu a less and a albw such Lmoeowness m etWV an bavW W fas kits o dtxs sot paaess l=nw,.pmvrded than the owmar oet as wrens a DEFIIaTION OF HOlOWI� m talde.t>tt wgddt these k of Y Petsoo(s)who owns a peed of WA a which)�>cs� � m MA tee aedl� intended to be.a late to two family HIA sba0 sot De outs A* farm svocum A perm who constructs come than me home in a two•year polod a homeoww. Such•lwmoo.TAe shaV subn*m the BuOdi4 OIIlalal,tm a Rasp ttoo ptabls ao ilm Building offic4 am WOm be uspotmbk m aD sock wok performed coda to bundbig W=L The wgk=ipcd'bomeowmm'Law ma tcspom''bMV for cmnp8tma with the Stale Bslldfrtg Code ad other appliabk goes by-bmM6 tuia and teguladomsi The mdwipvd'booteowmf=dfms thu he/she rmdastsrsls the CiW of Salem Bttlltlol De m=M. =,Wm=impenim Fo=dwa aid 7Nv,iTerrtcro5 and that htshc wm comeply Wilk said Poomdm a togtitrsmaw Holaow tE VS SIGNATURE APPROVAL OF BURDING INSPECTOR Sec other side fm sate code