11 VALIANT WAY - BUILDING INSPECTION 1 DATE: �/ p
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Building Permit Application For: Locationof Building
YCircle whichever applies) Roof, Reroof, Install Sid' ct Deck, Shed, Pool
Addition, Alteration, epair/Replac Foundation Only, Wrecking
Other: 4—
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: �t
Owners Name: DIf rn C o /) Contractor: A e' A 5jei"VIC251(!hn5 Q r7-
Street /i n City (L' Street-ll5 Nn(4h City (cm
State G6 } Phone ) State Mfl Phone- 078) 791 z.,0-'-{A H
Architect: City of Salem Lic# I 0 J
Street City State Lic 057733HIP*_ I I]I(o D9
State Phone ( ) Homeowners Exempt Form_yes�oo
Structure: (please circle) Single Family, Multi Family# Other
Estimated Cost of job S_ 9170, DO
Will building confirm to law? yes no
Asbestos?_des_Zno
Description of work to be done: `1
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A&A SERVICES, INC.
Drawings ub itted: es no Mail Permit to: 1 SA.LEM,MA 01970
R QZil)741-04M .
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Signature of Applic lion,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX MONTHS OF PERMIT ISSUED DATE
No. 113
AF,PLICATION FOR
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LOCATION
PEgM.IT GRANTED
APPR VFD
F P TOP OF 6Ui INGS
' CERTIFICATE. OF OCCUPANCY
YES
NO