SALEM MA 01970-5228 - BUILDING INSPECTION iAL�PS MU T-9E fiUEG-Ar O APPROVED By T44E
LNSP CTDA PIRWR TD A_PERMIT B,F_ING GRANTED
CITY OF SALEM
No. , 'ZOOM. ' � Date
4
Is Property Located In Location of
the Historic District? Yes_No_ Building m c'ASa')n S
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
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
Address & Phone
Architect's Name
Address & Phone L
Mechanics Name E
Address & Phone ( )
What is the purpose of building? m c/a"A-C ----
Material of building? If a dwelling, for how many families? S 1
Will building conform to law? Asbestos?
Estimated cost �/n O 0 , City License u N A State License a
Home Improvement
Lic. e
i nat Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
5TAt2S
MAIL PERMIT TO: ) 3 M(e0IJ ST
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
7 - 17 42, 03
APPROVFD
INSPECTOR OF BUILDINGS