11 STATION RD - BUILDING INSPECTION -PL-4f?BIMST-BEfIL-E# APPROVED By T+IE
WSPECTLiP ,PFADFI TD A PERMIT BEING GRANTED i
CITY OF SALEM
l
No. ��1/-06 4�.`� .. i r�, Date
s
Is Property Located in Location of
the Historic District? Yes_No Building �r S/O�/%s kan
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: Ren4a oc e
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:
K Owner's Name erg
Address & Phone
Architect's Name
Address & Phone �— I
Mechanics Name 4
Address & Phone �— 1
What Is the purpose of building?
X Material of building? Lt/,00c(7 It a dwelling, for how many families?
Will building conform to law? Yj o 5 Asbestos?
Estimated cost %D i a� o o City License n N P state License n /
Rome Improvement
Lic. I --
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION
OF WORK TO BE DONE n
�e 9lh Ca b, e f5
MAIL PERMIT TO: l(9 e own Q/�
� r
t
No.
APPLICATION FOR
PERMIT TO
/e e-,9,ee l �'
LOCATION
PERMIT GRANTED
317h"lo 2.o
APXPVfD
INSPECTO OF BUILDINGS
t