68 SUMMER ST - BUILDING INSPECTION ( 1
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pL-*N6i11 T.-9E fit,£� APPROVED BY T44E
,WSPECIDA.PRIORTDA.PERMIT9E SGRANTED
CITY OF SALEM
Date
No. AWL
IS Properly LWOW in Location of
OW HWA& DWfid? Yes NO
Is Property Located ti Su", /A 19 (5 l7-6
tM CaasrvaYoo Area? Yes NO
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Cons�r�ct Declt ed,. Pool,
Repair/Replace. Other:�' ^� _�f ^��m
PLEASE ALL 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:
Owner's Name 44 o
Address S Phone
Architect's Name
Address & Phone f
Mechanics Name
Address & Phone f 1
What is ua purpose of W Wlnp?
MON"Of brraldlrq? #a dwe",for how many Iamfts?
WE bWki g oontorm to law? Aabastob?
EdWAW/coa v 0 CRY ucen.e r N P` state UWAS r `
Haas Irptowsant
i'i`' Signature of A4plicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
unlrnL ,gyp Q "l n,. act U -
MAIL PERMIT TO: � ��
0 1
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
�la 2.0
PROV
INSPECTOR OF BUILDINGS
a