12 PEARL - BUILDING INSPECTION 1%2W4AVW11EfNAB4ND APIPROVEO BY RM
JhW CMQR PRIDR TO A PERW ARM GRANTkD
CITY OF_SALEM
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Permit to:
BUILDMG PERMR APPLICATION POR-
(Clyde whWw*w apply) Roof, eroof. Instal Siding, Construct Deck, Shed, Pod,
v . Olher
PLEASE PILL OUT LEGIBLY a COMPLETELY TO AVOID DELAYS m PRoCESSMq
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby Wiles for a permit to bulid axordwip.to the tkwkq
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Owners Name
Address a Phone La eArf-e �• ( 1
Archkeot's Name
Addross a Phone ( )
Mechanics Name _
Address a Phone ( 1
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SIGNED UNDER THE PENALTY'
DESCRIP110N OF WORK TO BE DONE oP PEIwRr
MAIL PERMIT TO: fa s i r e 4(S U l 2A,r(.e ST
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PERMIT GRANTED
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