10 PURCHASE ST - BUILDING INSPECTION iL1t11SiAklSt�E fK&04MID ,APPROVED BY T44E
Jd. ZCM PP" TO A.PEMIT=NO GRANTED
CITY OF SALEM
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is Propeny Locam in Location of
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is Property t oomied in
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, strut Deck, hed, Pool,
Repair/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 �1 ILA.21 a F
Address & Phone D
Architect's Name
Address & Phone i
Mechanics Name
Address & Phone f
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SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
J
No.
APPLICATION FOR
PERMT TO
LOCATION p
PERMIT GRANTED
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APPfIOVfD
I PECaTOR UILDINGS