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64 SALEM ST - BUILDING INSPECTION DATE: 'D3 c ftp of arPm, a, ar�uEtt� ,'ski o- • �.. M PLANS MUI;ST BE FILED-A,(,DAIyPAOVED?'BY THE IN MCTOiR,FRTRI OR TO A,P'ERMIT+pB',9'VgG iG°RANTED Build mg DPP PQ�IlII„� Ilcatioo For: Location of Building - - `(Circle whichcverrapplics) Roof .,Reroof, nstall Sidin 'onstrucl Dock, Shed, Pool Addition Altetatton, epair/Replace, Foundation Only, Wrect6ng Other; PLEASE-FILL-OUT LEGUBLY & COMPLETELY TO AVOID'DELAYS IN PPOCESSING ToAthc..hgp=or of.Buod pgs: ne unddisl'ped.h'ercby+:ppplies.for a pennit to build according to the following specificaii-ns: Ow.nerti Name_D!t� ��(�} 6 � Contractor: Ril_Ra"._rw,l.p Street leal Street nna�90 Cedar Hill PYtY# 0175 State Phone ( ) r-LSL__�!S� State Phone Architect; City of,Salem Lick MY Street City State Lic# _HTP a xx qj_z; State Phone ( ) Homeowners'Exempt Form .....Yes—no Structure: (please circle) Single Family, Multi Family q Other P2Agg- fn6D1140 IEstimated Coat of job S Wit{libuild�ngconPir®t_ il�tw7_yl cs no (AabA)SPA' n� e3 CC/o o Deaas`r�0tid 'of.wo ,done:_ I' S /U,/ Drawing �9 itted: es no Meil•i,rutil to: Si.t a off>Appi b�i!$I'` DER THE'PENALTYOPPERJURY CN't#5_i1BU'f3"i� Y Q; y 'QAAR'pyD+41 Bq'fVMl fdlN 50C ',NO iT,BS OF LAERMI fl4SS��1)''DATE ty (q L �2'co`` ,Department use otily,ruPd1 _ *ing_r Map/Lot -Permit fee S ✓C t SL r; 7 ' ,r t (, �� � o� � ��g D �� �I J hQ©-z C� YJ �