8 RUSSELL DR - BUILDING INSPECTION QS fIiS �@E ftL{-� ANC,"APPROVED BY T44E
IAISPF.CTL P R P` P T BSNG GRANTED
CITY OF SALEM
Date FJ
Is Property Located In Location of �J / r
the Historic District? Yes_No_ Building 'p /C� Qll/)W/�G
Is Property Located In
the Conservation Area? Yes,_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, er install Sid' Construct Deck, Shed, Pool,
Repair eplace, er:
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
,w Ur, / ,*Ao S J
Address & Phone 1�� � j10,04,
Architect's Name
Address & Phone � nsr'Sr f&9/�6l!/� wr
Mechanics Name( �. � ✓2;� 5 f�/�1��/ l�,� GA ✓�
Address & Phone
What Is the purpose of building?
Material of building? f a dwelling, for how many families?_
Will building conform to law? Asbestos?
Estimated cost City License# N P State Ll #
Boca 7mr ovese t �
Lic. /
GC Zq Lep ature of Applicant
SIGNED UNDER THL&IPENAL
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
C
, �
MAIL PERMIT TO: � 7 0
t
No. 4-5 2a ro
APPLICATION FOR
PERMIT TO
LOCAT[f)N
PERMIT GRANTED
19
APPRpYF,D
INSPECTOR Ct BUILDIP� S