63 PALMER - BUILDING INSPECTION i ~ •
WS,PECTD-A .PI�IR Tp' , PERMIT BRING GRANTED
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CITY OF SALEM
s'
No._b Il v S" �`� _� �� .� Date
ry. '
Is Property.Located In Location of,
the Historic District? Yes_No_ Building QwQIc
Is,Property Located in
the Conservation Area? Yes No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, 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 5-r 11P�
Address & Phone
Architect's Name
Address & Phone i I t
Mechanics Name g �IJI V -s 4
Address & Phone r/� �c ZQ�' tn()
What Is the purpose of building? Y�\ l S
Material of building? t \['Y_ If a dwelling, for how many families? y
will building conform to law? 4--5 Asbestos?Estimated
7mated cost ��T City License# N�A State License # [ 06
Home Laprcm ent
Lic. # 127�f
Si lure opplicant
SI NED U f ADER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: VC_r q'i C \�. VU1AL 0� Is, (��1`f'6
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
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