69 SCHOOL ST - BUILDING INSPECTION pL11NSVWT,*EfLeo4AG APPROVED BY 744E
jWX.C=PBIOR TDA.PEBYIT BEING GRANTED
CITY OF SALEM
is Ply Lomw in Location of rr G
ow HwAft omem? yak-No_ laUAUw
is Propecty l orilad in S)S ePi1 :
Mn Coiwrvellon Ann? Yns No
Bin' ING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
RelwiReplace, Other:
PLEASE FILL OUT LEGIBLY i 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 Wa Lh ui;� /1 a g h o it
Address S Phone l0 9 S e, f f97f 1 7 4141 ,� P 6;2
Architect's Name
Address A Phone f )
Mechanics Name D a LY ,' ,l a ;X n n
Address A Phone l as Gan a n -L ST (7 7A -7-7�j
-D Q✓iU�S
What is Yr p ipm of a,Ydrq?
Meow at kmaq? L. d e o k I a d womG,for now many Wn wb?
WIY WON Oman to law? ye-.s AWW"? No')
z n aw owl I Q, a r) D CRY www r N A slat.Um"ii C✓S n a.o.S Z--
Yor imvww nc XP'1 a /L r) '. h� �� � )
Lic. 9 �SigWufo of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT T0: � t o w f
No. —a d
APPLICATION FOR
PER/Wr TO
`,exrz,,-o J/[X Ploy 117.+
LOCATION
PERMIT GRANTED
zo
APP ovfD
IN PEC,'TOR OF BUILDINGS
�K
V-4* 5-j J
a'?H 9 6'-/? t} � ft i