3 S MASON ST - BUILDING INSPECTION � s
gPLAWMAIINTIBEfl' ANkWo APPROVED By Z4IE
WIRECUIR PWR TD A:PERWT BEINO GRANTED
(�S CITY 0F_SALEM
N \\ ` " Date 9 O rl y
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Permit to: BUILDING PERMIT APPLICATION FOR: -p
(Chle whichever apply) Roof, Reroof, Install Siding, Construct , Shed, Pool,
Repairmeplace, Other. i
PLEASE RLL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS N PROCEBSM
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build aocordiig,to the following
spedflc stions:
Owner's Name
Address 6 Phone 1" 9 fa H-cu �V?s 2tn 9 £f� 6/
Architects Name 1j
Address A gone , ,
Mechanics Name 1
Address 8 Phone ( 1
WhO is In pupm it b~
few of bWldlrg4 b 1tP r_l n a for how nor NOW 'JVo 4V
wa b AdIng oo ft., to law? AebmW o(A
EwnNlad oofl°r (' 1 Coy tkaiw r Ureo4fAipl
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ev.. r�so+a.ase
it
8fIli81ED MOM THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
r r-0,11 ) t� Y27 b u�►M.
MAIL PERMIT TO: QN-trrA )C9(p RAH k-R) P,-V Qod&r-j MK- d0' 67
i
No. ;
APPLICATION FOR
PERT T TO
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LOCATION
9
PERMIT GRANTED
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INSPECTO F BUILDINGS