8 ORCHARD ST - BUILDING INSPECTION -pL-* lSjAVSfi�KftL*9-ANG APPROVED BY T+IE
IN$pECIAt1 pWOA TD A.PERMIT UJNC GRANTED
CITY OF SALEM
No. it
k/
is
Is Property Located In location o
the Histode MOW Yes No ftdidin8 C
is Property Located in
Me Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidin , Construct De Shed, Pool,
Repair/Replace, Other:
PLEASE FILL
OUT LEGIB LY&COMPLETELY TO AVOID DE
LAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name �e-ese ��n .-e�
Address & Phone co
Arehilests-Name
Address & Phone I
Mechan e
Address hone I
Whet is fhe purpose of building? rP i\Le'r" - -
MateAel of b ulkllrrg? If a dwelling,for how many tamllies?
Will building conlorm to law? k45 Asbestos? \M o
Estimated cost t o(3G,C)o Ctly ucerw s N k State Wines B
CV E®e Isprovewant
lJ V v Lit. t
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
G
��e�
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
e/1/0/0 2.0
AP OVfD
INSPECTO OF BUILDINGS