12 RUSSELL DR - BUILDING INSPECTION Sidlii6reE FILfB-OAdD 'APPROVED BY T*IE
.IMI$I0;E jW PEA �D 1 PEBWT B,EWG GRANTED
rr
CITY OF SALEM A
N
No. 4 2 2b oy ,�,�` �i�. 'p Date
Is Property Located In Location of
the Historic District? Yes_No_ Building D���
Is Property Located In
the Conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roo Reroof nstall Sidin , Construct Deck, Shed, Pool,
Repair ace, ther:
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 COrydO
Address & Phone
,l�&O,t3/L��,/'YII/�, (71l ) %3. -RA 2-
Architect's Name/t/06 ArlrY'
Address & Phone—/�/yfe� ILK G /� ( n27q 06 -
Mechanics NameWSiI.
Address & Phone ��� /�� � �-�7�f�X1Ow
What Is the purpose of building?
Material of building?&A r/�f a dwelling,for how many families? l
IF
Will building conform to law? Asbestos?
NA 4DEstimated cost _�,Do�. City License# State License#
t A S Home Imp ovemen
�t Lic. 1�j3
CAC 2q�¢a Signature of Applic t
SIGNED Uif E HE PENAL
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
ZE
MAIL PERMIT TO: cSI�
t
NO Z-Zoo y
APPLICATION FOR
PERMIT TO
LOCATIO�f
PERMIT GRANTED
19
APPSOVED
_
INSPECTOR OF. BUILDINGS