101 TREMONT ST - BUILDING INSPECTION IM-*NS-MttST-BE fiLff;-ANO APPROVED BY T44E
.M.P XTD-R ,PR R TD.A PERNDT BFJNG GRANTED
CITY OF SALEM
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No. 200cf Nam`? ',� �'\ Date
'.`�utiti . iia
Is Property Located in Location of L
the Historic District? Yes_No Building O I T(emon+ --I
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: fxiAhmom Pmov-Lr k
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: nn
Owner's Name {3AQs�o nw\� Ted
Address & Phone \0\ (ql) -7 kin G14G
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What is the purpose of building? n Material of building? l✓!4yn It a dwelling, for how many families?
Will building conform to law? ��P S Asbestos?
Estimated cost tT 4, 5Dh City License # N PA State License #
d Rome Improvement
Si nature of Apolicant
LJSIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Floor
MAIL PERMIT TO:_��nQ�
No. Z `1q-2Oo � (
APPLICATION FOR
PERMIT TO
/GtrmlJ h2��
LOCATION
PERMIT GRANTED
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APP O FD
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INSPECTOFKOF B ILDIN'S
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