11 RUSSELL DR - BUILDING INSPECTION jAtiSfi-BE fiLfgW&APPROVED BY T+IE
IRIS J=CJLR ,A,ADIA 7P�4 PEf31CAlT BEING GRANTED
CITY OF SW`LEM
No. 46 —zoo Date
Is Property Located In Location of
the Historic District? Yes_No_ Building /J t!{SJri!// Q/KyyG
Is Property Located In
the Conservation Area? Yas No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Re or Install Sidin , Construct Deck, Shed, Pool,
Repair ace, t err:_
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build a cor I to the following
specifications: ��
Owner's Name pGXr/I,�x/�i9�P�(CD
Address & Phone (787 ) ?-7,P—Zgvj
Architect's Name *IoezxJ-
Address & Phone y/rl, &t/7f 06��
Mechanics Name l` ow 'e7 >S- /*wl"y
Address & Phone Lkzff2 D � %� ( fig 8 yy�3
What Is the purpose of building?
Material of building? . if a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost 9, dO0 Gty License# N "' State LI se #
Home Improvemen
M. i
nature of Applicant
Gy-Zq y j�SIGNED UNDER THE PENAL
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: C/Z OII°� Zg� ✓��/��Gel �07l>d
f
NO. n�
APPLICATION FOR
PERMIT TO
LOCATION:
PERMIT•GRANTED
*v 19
APP�VfD
INSPECT OF161JILDINGS
•