3 RUSSELL DR - BUILDING INSPECTION �L 4911iS� 6Efilf iidD APPROVEO BY T+IE
. ,;EabB # DR Tg;„/� . ."T B,EWG GRANTED
CITY OF SA"LEM / J
No. C 1 ��� j' �� �i Date
Is Property Located in Location of
the Historic District? Yes_No_ Building 3 hu,&// AIR"
Is Property Located In
the Conservation Area? Yea_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Rero nstall Sidin Construct Deck, Shed, Pool,
Repair ep ace, 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: ,�4l�f�dU �/ n
Owner's Name /'L /7C/1 GUf7Ud/ /mellow Yy7S
/�
Address & Phone J7V m 1�Y1�J��/¢1P� j 8/) 9�3 :22
bIJCAY& l �I
Architect's Name 4/ncccu 4, Bo� r S
Address & Phone y iO,Sr P tII// �/1JQ(. f 22229 63L
Mechanics Name mywA ///l ,11i�14 5,
Address & Phone /7 4L_;,zA xCP,7
Whet Is the purpose of building?^/!'l�
MOR
Material of building? I a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost City License# N/A. #
119Oo� Bone Imp�/ovAent K;ignAaturselo4fAPipplica'n't
Lic. /
SIGNED UNDER THE PENAL
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
/ 14,9,11P00 7 i' 1dzv5
slleld aa
MAIL PERMIT TO: ✓�SZ/srz mw
t.
r
i
No. qL4-2,0b'�AN
APPLICATION FOR
PERMIT TO
LOCATLE)N
PERMIT GRANTED
19
APPI3OVfD
INSPEG-T BUILDINGS
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