15 OLIVER ST - BUILDING INSPECTION qPLIMIANTIBE flb4NWM APPROVED BY TW
JNAPf.C=PIER W A PERMIT aRING GRANTED
CITY OF_SALEM
\ ward
Zoo"DMM
Is PMMW LOGMd in 8
i t:Um of
ON a"smic owed? Yo—No-1.6/- Daildioa 1 G�YYIll
ft Carw 42*m Ann? Yes—No V Permit to: -
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof. Install Siding, Construct Deck, Shed, Pool,
Repair/Repiace, Other
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accordGig,to the.folbwing
spedRoations:
Owner's Name
Address A Phone 5 -y
Architect's Name —�
Address ik Phone
Mechanics Name n
Address 6 Phone U � �� i/ �
wnN is dw p.pm if tar~ -/
m"w of txlldrg9 C-y Mad" 0q,for now mmy faman4 /
WE t to ft ca "', to low? A�hapot+4 /Y
Edf nvM cat b 2 civ umrme N N
Signature of t
80M UNWR THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
i�ilo r
t�Piy-
�ila-tee
MAIL PERMIT TO: kzzl�
SONG 1 8 :10 WIDUSNI
aiA0�1/
a3iwuE).unu3d
N MIVOOI
QL J MMd
� _7 �