3D STILLWELL DR - BUILDING INSPECTION -PL-MS*WSt-9EfII.e94AG APPROVEO BY T44E
ASPELILIR p,p" TD A.,PEANUT BEING GRANTED
CITY OF SALEM
No.�T 6 Date�Ze7
i"
it
is Property Located h Location of
Uw HMO& MAW? Yas No� ]sodding 3 D 8T160A t ZW,
is Property located in
ttw Cauarvation Area? Yw No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, In Siding, Construct Deck, Shed, Pool,
Repair/Replace Other* /. IjA'D,c"s
PLEASE ALL OUT LEGIBLY r4 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:
Owners Name RAP-sRAga DEE —
Address & Phone 3D S-rli l-WiE x- 4R (y'78) 7yS--736-0-1
Architect's Name
Address & Phone I )
Mechanics Name SuN„6rte FFE E4-rPnS
Address & Phone qg& ;PA)-Pi E S. CaN>oAJfMR ( 7A) Q I --2-?Q0
WhM is the purpose of buildtrg?
tiAd"a WON? B a dw"N,for how many lams?
ww bu w*cordorm to law? Asbestos?
Estimated cost 7— Gly ucer"s N A Slate Lim"0 -
,�X Horse improveant6ber V n
C� r.ac. IF 0a6Y7 ,A1 Signal re of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
/C�J�LACEMEwIT �!lJDOaJd
MAIL PERMIT TO-
No.
APPLICATION FOR
PERMIT TO
�L 4C¢p/iAb—/.J/Nae4d�5
LOCATION.
30
PERMIT GRANTED
27 2 t) a 6
APP OVED
�p
Z�.
ECTOR OF B ILVINGS