24B PICKMAN ST - BUILDING INSPECTION qP MIG1MT13EALf9#ND APPROVED BY T44E
ASPACMR PRIOR TD A.PEAMIT BEING GRANTED
CITY OF SALEM
No\ Date
Ward
ZoNrg DMIct
Is PmperlY Located in Location of l the Hl oft DIstrld? yes
No_ Building
Is Pia"IV Located In Y
Qn C 10a vatlon Area? Yet NO
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck Shed, Pool,
Repair/Replace, Other:
PLEASE FALL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned herby applies for a permit to build accordriq to the following
specifications: /
Owner's Name &e-e� ��/X/
Address A Phone _a `lh A laC41�CdI
Architect's Name
Address & Phone I
Mechanics Name
Address & Phone
What Is the Pupae d bWltlkq?
MdwW of btridlrp? P n a dwaft for how many ramose?
wa buk*ig canrorm to taw? 5 Asbestos?
EiRnated coat.C� CnY Liana.N rate Ua e
aomm mat
Lin. a =
Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
kildl'46
k0l 4fC4 4/a AS 4o 4
MAIL PERMIT TO: aG1.C� /iU?GGl/slur �� c G�� �Ol97d
(1 ,
No. v�
APPLICATION FOR
PERIINT TO
LOCATION
PERMIT GRANTED
1/0 1-/ 19
T-
AP VD
INSPECTOR Of BUILDINGS
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