67 PALMER ST - BUILDING INSPECTION (2) 1M ST-ef f l:-EG�,A?PROVED BY T+IE
WS+PFX3DDR ,PRWR TP.A.PESMIT.B,EING GRANTED
- CITY OF SALEM
No. '�1O _ �:, ` � Date
Is Property Located in Location of (� #/
the Historic District? Yes—No_ Building Q QjAAZ.( .�
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,
epaidRep ac�yOther:
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-re,4-� t�
Address & Phone �0 I-e-r6A
Architect's Name
Address & Phone
Mechanics Name � UtlOC�S
Address & Phone � Y��,e o ����� (7` ( 132Leff1(
What Is the purpose of building? A p r
Material of building?,ya<t�f If a dwelling, for how many families?
Will building conform to law? Asbestos? Ae>
Estimated cost City License n N A State License a
Hime Improvement V
Lic. E �' rAq �
i ture of Applicant
SI ED UNDER THE PENALTY
OF PERJURY
(DESCRIPTION OF W1ORK TO BE DON1E
1V e i 0-,0— (���j
Ii IL L Al emJ 6 Y ,4&-x e \
MAIL PERMIT T0: A QJP11C
'1
No
APPLICATION FOR
PERMIT TO
Y µ;
LOCATION
PERMIT GRANTED
APPROVFD
INSPECT- OF BUILDINGS
i
t 4-6
EXCLUSIVE USE
UNITS 9-12
BEOROOM
6EDRW)A 6
BATHRCL
A
CL HRVF H 1 MAIN
EN CE
i '
UNIT 9 � �
AREA �L F� S1sfirjpe
lia
1089 $ S.F. BEDROOM
p117)l �%�
mom
EXCWSIVE USE
• �-- UNITS 9-12
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