5 ROPES ST - BUILDING INSPECTION r 1
NO.\
APPLICATION FOR
PER&W TO
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PERMIT GRANTED
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INSPECTOR OF BUILDINGS
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CITY OF SALEM
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Permit to: BUILDING PERMIT APPIJCA71ON FOR:
(Circle whichever apply) Roof, Remd, Install Siding, Construct Deck, Shed, Pool,
RepaidReplace. Other
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build aocord4ig.to the following
specifications: r
Owner's Name M I IKL�k K{q-N f01�-Dcf
Address A Phone K,0 FE
Architect's Name
Address 6 Phone ( 1 Mechanics Name 019-►M 9 -KPI G2. <7 Gf.jvc( p L)✓
Address & Phone 30 Myl< 71,e v9u s k ltF-�/o
33 '1S
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S re of Applicant
UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: ( �� ��Uc(care
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