29 STATION RD - BUILDING INSPECTION f *M1ANTINE fILA94019 APPROVED BY TW
JMBPJI CMB PWOR TTI A.PERW BRNO GRANTED
1 \\ CITY OF_SALEM
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Is Ply Lamed to
i dN CWWWva on AM? YN No
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) R . Install Siding, Construct Deck, Shed, Pool,
Ispair/Replace Other
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSNG
TO THE INSPECTOR OF BUILDINGS: '
The undwsVW hereby applies for a permit to build accor&g.to the following
specifications: ^I
Owners Nam@
Address d Phone 9 S I� (c,n R o-d S 7 G ? go ?
Architect's Name N /A
Address A Phone '-) /
Mechanics Name N/
Address 6 Phone /
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Suture of Applicant
SNOW UNDER THE PENALTY'
OF PEwuRY
DESCRIPTION OF WORK//TO BE DONE
MAIL PERMIT T0:
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HOWOWM'S SIGNATURE
APPROVAL Of BU=rNC;INSPECTOR
Sm otba side fa sou Code
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HOMEOWNER'S EXEWW-nON
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