14 SABLE RD - BUILDING INSPECTION No.
APPLICATION FOR
PEFWr TO
LOCATION
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PERMIT GRANTED
vs f Zooms
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R OF 8lA 'DINGS
fL*N *lVST*EfILtg~ #J"OVED BY TW
WPECS118 PWpR W A PERWT BEING GRANTED
CITY OF_SALEM
No. Dw B
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Loeatioo of
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Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Remof, Instal Sidfrtp, Cartetruct Dear, Shed, Pod, \
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSM
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build aocord4ip,to the kftwhg
specifications:
Owner's Name �iQIC>
Address & Phone ���'��� ,�r/ (p781 7�S-3�a%
Amhitect's Name
Address & Phone ( )
Mechanics Name
Address & Phone
Whet Is the parpm al eulldlnp? K Ps i r/e yi c P
h�h.n,w a hariarq? M a dwsllNq,for how amy tempo?
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Chly lk«w r 80gr Llo�w r
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Lic. Ii
Soature of Applicant
BKNM UNDER THE PENALTY'
DESCRIPTION OF WORK TO BE DONE of PERJURY
MAIL PERmrr TO: