33 PARK-17 PRINCE - BUILDING INSPECTION 1,
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
-7 —I F_ c) _ 19
APP�VED
V Gb ' o
INSPECTOR bF BUILDINGS
DATE:_
�itp of Mr KamMrbu5W5
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR'PRIOR TO A PERMIT BIKING GRANTED
33 Pa-kK bT-/t 7 Fria
Location of Building _,
Building PermitiApplicatioo For:
-(Circle whichever,applies) Roof,Reroof, Install Siding, Construct Deck, Shed, Pool
Addition, Alteratio pau/Replac Foundation Only, Wrecking
Other: • `
PLEASE FULL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
pB
The undersigned herebycapplies for a permit to build according to the following spacificafi-ns:
OwoertiName:SALe�k aA y Ik _ Contractor: ekJJt2oarJd;0T-+L- AC51b4+J70-7
Street R 7 CAA(L�•k ST City Street_ /& P& t;iry +�A gpsr
State t r+ Phone (178) M-443! State ik) I-( Phone (God ) 3ALC1 -6fo I
Architect:C,R,H zhoc, ✓t-Lcr(o AuiJ City of Salem Licl(
Street t,, Tttc 4.4,c5°,L City r 'iitOLa4/, State Lic#C So4W3i HIP N 1 1 7430
State Mo Phone (791 ) to 3 1 411 qrj Homeowners Exempt Form ves no
Structure: (please circle) Single Family, u!!iw i F 0 Other
Estimated Cost of job S 49 b,000 1K( 1 n T M9--'zM- 'pev-",TS
WiWbuildiog coofirmAo=law? ✓ yes no '
'AAsbc'stoa? _yes �o
,vescriptidu'of works 'bc done:— '9rPLA'cC- Ec ren to-t 0 o025
CfU Spa pe"o woop *,Pe Pow,.(•
Drawings Submitted: ✓Yes no Mail Permit to:
X A rltzw-
Sigoature pOleiltion; RUI =ED +:IDEIR THE PENALTY OF PERJURY
vaN'sTitum OJEWLETED WITHIN SIX(6)WONTUS OF PERMITa1S$I1ED DATE _
Department use,only:; Perj{lif#3 j4 Zanin
Permit fee S I DO
COHKENTS:
I • :•