10 RUSSELL DR - BUILDING INSPECTION -Pt*4S1MJSt- E fiL£0.4N0i-PPROVED BY T44E
IAIcC7L ,p3ldpAfp'l;• PFJT f3(rWG GRANTED
CITY OF SALEM
No.A ✓—ZOO yam`` N �� Date
iI
Is Property Located In LQcatlon of y� �
the Historic District? Yes_No_ Building
Is Property Located In
the Conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof�ero� Install Sidin , Construct Deck, Shed, Pool,
Repa'jWRbplace, 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 U.Y/OD
CG, Cl�t�1 S /�r�
Address & Phone �{�P� m - p�� 1 :02 902
Architect's Name �L �X/ f✓p✓�Z�� �` rr'
Address & Phone yes>S',f�A �i"�,� A a2?—0dc�/
Mechanics Name C611W49
Address & Phone
.�780
What is the purpose of building?
Material of building T� lI a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost °T city License rt N P' stat License M
I�5 Rom Imp ovasentl
Lie. i �>3X54*47
ZI Lt v Signature of Applica
SIGNED UNDER THE PENA
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
0/1
C,
LIF
MAIL PERMIT TO: � �g�
No. u 3-2,pzo
APPLICATION FOR
PERMIT TO
L '
OCAT!
PERMIT GRANTED
_ 19
APPROVED
INSPECTOR OF BUILDINGS