65 PALMER ST - BUILDING INSPECTION ,
CL
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f4.9kf �elliST�EffL£CAND AfLPROVED BY T44E
PFWR TD A PERNT BEING GRANTED
4.
CITY OF SALEM
N0 tf� Z fe y. *a�i\ Date 6
6
Is Property Located in Location of d
the Historic District? Yes_No_ Building y R,LivIG,i
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,
e�al l! , they:
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
Address & Phone W k e-r' " � )k
Architect's Name
Address & Phone
Mechanics Name �� �
Address & Phone 2 t HI 2ft4l f 7PT
What Is the purpose of building? ,
Material of building? 2R L If a dwelling, for how many families? L
Will building conform to law?— Asbestos? i�
Estimated cost ��•� City License# W/o' State License #
Home roveeueent x
�' i /\ Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
1 �e ( y9r- Pi f S rt�t uJ l w /v
V 9� ICrAx�-
MAIL PERMIT TO:& ee � •
� G�UIycG�� �� lf6t4(X0J NA A-
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No.
APPLICATION FOR
PERMIT TO
LOCATION.
PERMIT GRANTED
cz ��
APPROVED
INSPECTOR OF BUILDINGS
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BED O 1 N ow
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I 34.0' ,; 1
KITCHEN
1 '
MAIN
ENTRANCE
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I Rt9OM I 1AM.
RAT
6 i i DINING 1
1 I I ROOM I
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