6 - 6 1-2 ROSLYN ST - BUILDING INSPECTION IMAM 1AUSY19E fIlLer V* AwP ROVED 8Y T+IE
.WMPECTDB PFWR TD A PERMIT BENG GRANTED
CITY OF SALEM
L��No. Date �n
Ward
Zoning District
Is Property Located In Location of G — (o r�2
the Historic District? Yes No_ Buildingf-
Is Property Located in
the Conservation Area? Yes No
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, 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
Address & Phone (9 — G f�Z Kos f�,� Sf f � S 3 2—
Architect's Name
Address & Phone
Mechanics Name f Urn 4-p�JO -14- �W?
Address & Phone 3�/j �j—/-P,Qt70 J gj (' 3^ 7067
war Ce 3 A,-
What is the purpose of building?
Material of building? If a dwelling, for how many famities?
Will building conform to law? Asbestos?
Estimated co.,e> /z-, GO C) City License k state License k
� Aec. Inproveraent ��, DD Lic. III
Signature of Applicaivr
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE 1
MAIL PERMIT TO: / / l 43�20
2 y f�elh�rn st
6 i&66 51
.t.
No.v�
APPLICATION FOR
PERMIT TO
LOC ON�� � C
PE bwffGRANTED )
APPROV�D
INSPECTOR BUILDINGS F
O