2 STAR AVE - BUILDING 14*NS11WST-9Ef#W #ND APPROVED BY 744E
JNSPEMDB PRfaR TD A PERMIT BEING GRANTED
\\ CITY OF SALEM
No.1 �1 N _
Date
Ward
Zoning District
Is Properly Locabd In , Location of
Me Historic Di dict? Yes No k Building 2 51WWL Rve7--
Is Property Locetad in
are Conservadon Area? Yes No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof Install Siding, Construct Deck, Shed, Pool,
Repa eplace 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 accor&,Ig.to the following
specifications:
Owners Name VAt CCA�C(_ IAofLs�cY
Address & Phone 57PrCL A J "r (1781 '?40 8-2(S`
Architect's Name N'�Lss
Address & Phone R7 tom, d s-U
Mechanics Name
Address & Phone
What Is the purpose d fwNding9
fdef rfaf of fain ftv Wao'�X> If a dwe&q,for how many famon?
WNf WNdng conform to law? T Sn Asbestos? 1 -O
Esdmated cost Z,5M— Gty Ucenw a Stab U w a
Nome Leptovaraent
Lie. f
Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: ,� I
.t
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
APP OV�D
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INSPECTOR Ofe BUILDINGS
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