71 TREMONT ST - BUILDING INSPECTION (3) 4PL*NBIIRISTIBEfiLA11114ND APPROVED BY 744E
ALRECTLIR PPJCkR TO A PEBW BEING GRANTkD
CITY OF SALEM
No. �— oati
ward
Is Pmwly Locam In Location of
rN,"manl*r MOW YN No, X aalldisg �� I�Qa,�n� 7 -
4 PmPwty Looatrd In
rw C rommaaon Ann? Yak_No X
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Retool, Instal SS Construct Dads, Shed, Pool,
Rapair/Raplsce, Oltw.
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOW DELAYS W PROCESOM10
TO THE INSPECTOR OF BUILDINGS: '
The underapned hereby applies for a permit to build accor&q.to the.followinp
apadflcations:
Owners Name Ck� a
Address & Phone 7/ Tlfmv, y St`. 0/970 (97?1 ?e-11- 1464
Architect's Name
Address a Phone ( 1
Mechanics Name C��, ya o X, �e
Address A Phone 53 Mi/W&E ,C7� ' � ( 6171-6 b 9-7 7 71
Whtl is Va p apora it blrl*W
m"m or kddw M a r' 11 1p,for how mmy lament?
we kook D caMonn to law? Arb0WW?
EvW Mgd coat X 8-(,o 0 m uo r swm Ltorrlra r 3 a s� Z
tro.. Lwrc M'Mt
�3ea'/ z / C-
Siprwture of Appficeht
�J SKvWD UNDER THE PENALTY'
OF PERJURY
DESCRIP//TION OF IO/RKgqTO BE DONE LLe
MAIL PERMIT TO: 53 Nc lni Ps S�r�—f, 62t, .n
/ Lnnd"nq Lsn,{'IrN e'" h
APPLICATION FOR
PERKW TO
LOCATION
M PERMIT GRANTED
21221
APP FD
INSPECTOR OF 9U1 S