0007 PICKMAN RD - BPA-06-357 -PL-*MIAWT-SEffLf� APPROVED BY T'*IE
.WSPFXTDB PRIDR TP.A.PERMIT B,EWG GRANTED
i14
CITY OF SALEM
No. / '� ��• .� �� Date /O
A//
Is Property Located In Location of
the Historic District? Yes NoS� Building
Is Property Located In
Me Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
air/Replace, Other:
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 % /Lir' a lz
Architect's Name
Address & Phone
Mechanics Name
Address & Phone !LfLRr u�4� 6oc /L,�4 (;Zj 2
What is the purpose of building?
Material of budding? If a dwelling,for how many families?
Will building conform to law? Asbestos?
Estlmated cost City License • N ill State License o G
Hoae Improveaent
</ Lie. ! G
Signature of Aliplidint
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
CT �0 lf6 o
MAIL PERMIT TO:
No.,
APPLICATION FOR
n PERMIT TO
ell
LOCATION
PERMIT GRANTED
AP ROV�D
INSPECTOR OF BUILDINGS