4 PLANTERS ST - BUILDING INSPECTION P 1 INTIDE fKAB4011) APPIiOVEfl BY 744E
ASPJ:C=,PWR TO A PERMIT BEING GRANTED
CITY OF_SALEM
No. \ Data
Wad
ZW*19 DOW
rst Ny umated Dikt7„ Yen No Location of
Is Properly i ocNed in
Bn Consmation Area? YN No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: I ti
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '.
The undersigned hereby applies for a permit to build accord-ig.to the following
specifications: l !-_
Owner's Name /�1 )f //l 61m fva y�U2Y1q .
Address A Phone `7 /914y) �
Architect's Name
Address A Phone J� L ( 1
Mechanics Name /70�2 Lao
Address 6 Phone y nonWc�,)c�wrW Is the purpose of mmew i kcq vllti�
Mafedei of b~ n a dwdwrg,for how mmy farness?
wa b A ft conform
�to law? Asbestos?
Eseneted cost %/ Cqy WWW s Suet umm e
Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESPWTIPN OF WORK TO BE DONE
l7 � /
MAIL PERMIT TO: `-
-ALl,k7js rn , � a � e79
No. 1\ -6
APPLICATION FOR
PERNT TO
tf
/ toy«
LOCATION
PERMIT GRANTED
APP OVFD
INSPECTOR OF BUILDINGS
Y..'