34 UPHAM ST - BUILDING INSPECTION (3) -PL-*NS-MOST-BE fii£S ANO Af?PROVED BY 'T44E
CP T PWOR Tp A.PEA1H11T BFJNG GRANTED
p\\ CITY CF SALEM
No. �� Date_7 /
mNE
Is Property Located In Location of 3
the Historic District? Yes_No 4z Building
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: k- i i c-Nor/ / 13* 1 r/
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:
Owner's Name Lo�-Z-A {'
Address & Phone N d ✓ 3 73j.
Architect's Name
Address & Phone L I
Mechanics Name
Address & Phone ( 1
What is the purpose of building?
Material of building? Ly e a d If a dwelling, for how many families?
Will building confopfl to law? :�j Asbestos? C
Estimated cost 00 J City License# N P. State License #
Home Improvement
Lic. i
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
4a,411] oj< c
MAIL PERMIT TO: I/&A-^ C 72 Jt,�, LJr� /r'1'`fs S•
i
w Nn
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
ZQ
A ROVFD
INSPECTOR OF BUILDINGS
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