65 PALMER ST - BUILDING INSPECTION (2) a
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.A.PET BEING GRANTED
N
a - CITY OF SALEM
No. Date
•
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Is Property Located in Location of [n�
the Historic District? yes_No Building Co5 pcuUVC 3
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,
epai ther:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDI
NGS:
The undersigned hereby applies for a permit to build according to the following
specifications: ,r
Owner's Name
Address & Phone tO &014!z
Architect's Name
Address & Phone
Mechanics Name
Address & Phone 21lding?
What Is the purpose of v
Material of building?� L-C _If a dwelling,for how many families? _
WIII building conform to law? Asbestos?d"
Estimated cost �Gity License r N A State License *0—& �r
Home Improvement /
Lic. I Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
n �
ses
A.� 17ll� 1,tX
MAIL PERMIT T0:
1
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No.
APPLICATION FOR
PERMIT TO
LOCATION
' ^
PERMIT GRANTED
APPROVp
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INSPECTOR OF BUILDINGS
h
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1 k
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BEDROOM 1
1 i � I BEO�OOM
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I CL. �M 36X a
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1 MAIN I
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ENTRANCE
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