1,2,3,4 SPRUANCE - BUILDING INSPECTION I
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.1ALS��:;ECJ� �';�AA �TP'A P.EA�IIT.�,�WG GRANTED
CITY OF SA`LEM
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Is PropeAy Localed In — Location of / .� 7 � �u IG�
the Historic Dlstrict7 Yes_No Building �f�
Is Property Located in
, ihe Conservation Aree? Yes_No_
BUILDING PERMIT APPLICATION FOR: '
Permit to:
(Circle whichever apply) Roof, Reroof Install Sidin Construct Deck, Shed, Pool,
RepaidReplace, 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 �-����� ��QO/�L�.�Ic.�UIY! _
G/0 � .T. D
Address & Phone ,�D ui, Cl!/j'!�'l�i1�IS �i�il°!��/D�!!/��1�/" 7��� ��c��
Architect's Name ,�/oBG�rr ,�i�<Z�
Address & Phone �S� ✓�,��i���0� �D� �7f/06�i li
Mechanics Name �l�l,�/ !!, ///�/Li�l7 S �//L'��S G�Q���J -�
Address & Phone 9GGz�.�,o sr, �i�,�,�v (� �3-�/�l_3
Whet is the purpose oi building?
Matedel of bullding?��� /lriY'JA,O II e dwelling, for how many families?�
WIII buliding confortn to law9 Aabestos?
esumated cost d00 c�ry ucenae K N A stete ucense a D?�Q�.�'i'
Homn Improvment '
� ��� ��� � `� Signat� of Appiicant
C� �q � ( SIGNE' UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: � �/.�%L�OiP�J 4STi �l�C�i1�DlU. � , Oa�Sd
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No. 6 'J r Z(D o
APPLICATION FOR
PERMff TO
LOCATION
1, 2,
PERMIT GRANTED
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