13 SOUTH ST - BUILDING INSPECTION DATZ: -7-i s-o
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Building Permit Application For: Location of Building /3 �. yy
(Circle whichever applies) Roof, Reroof, Install De*Shed, Pool
Addition, Aheratio RepaidRep pqu dabon Only, Wig
OUuer
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AV.OD) DELAYS IN PROCESSING
To the Inspector of Buti)dings:
The undersigned hereby applies for a permit to build according to the followiug:pecifiadoav
Owners Name, �I//l9rrzo Contractor.
Street �$f City &lei/ Street �� ,
Stan f Phone (9?8) 7Vy -7S79 State Phone( )
ArWtact' City of Salem Licl!
Street C►t) State I&#
State Phone ( ) Homeowners Esempt Formes ao
Structure: (please circle) )ogle Family. old Family N�Odler
Estimatad Cost of job S 3ov - o 0
Will building confirm to IW. �yu
Asbmu?___ya Kp
Deaeriptian of work to be dose:
a411 OI�B/ �an�i over
Drawls Submitted:_ya no Mail Permit to:
Signature of APp� u, ;.GNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION T B ' OMPLETED WITHIN SD( MONTHS OF PERMIT ISSUED DATE
Department use only: Perm4
Permit fee S
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