40 SUMMER ST - BUILDING INSPECTION -PL-A"S MttST19Ef4L+G--AN0 APPROVED By T44E
,IW9CTI?A ,PBWR TD A PERMT.B,EING GRANTED
CITY OF SALEM
No. -�'�' ) ,�:'`. � �\ Date
Is Property Located in Location of n
the Historic District? Yes No_ ,x Building b. J 4MKtr
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:
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: j�
Owner's Name /� ' l �
Address & Phone 7 0 Ch (71) 82-f-qm- x 63
s Architect's Name
Address & Phone ( 1
Mechanics Name z
Address & Phone ( )
What is the purpose of building? 2a- A,."
Material of building? r'V/"k If a dwelling, for how many families?Will building conform to law? Asbestos?
Eshmated cost �-060 ' City License # N P' state Li nse p
\ Hose Improvement
S ( Lic.
to of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE ( f ^
+ CiesiP�^� CA . i dA cr!OVr Kam �i 4da,,X If I;
MAIL PERMIT T0:
No.\ ��
APPLICATION FOR
PERMIT TO
L,QCATIONc
PERMIT GRANTED
2.0
APPROV�D�
J
INSPECTOR OF BUILDINGS
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