63 VALLEY ST - BUILDING INSPECTION (4) ftlMI IRWOR"doo O *AWROYEO aY Im
�f]�D�A=lily AI�IrG GRAIi1�D
CITY OF SALEM
oro iy
wrld
M NepwM bored in Lwatlaa of 63 VA d d ey s f
b lUlwlo r N I YL NO JL as Aft
Y Ropwly Looted YI
MOauwvldanAm? . Y6k_Ne_
NfL� �>rAPPNCAIMlOR:
Pa"b:
(Grob whldh apply) Hoof, PAmof, dll CWWW o ok SWK PMA
"Wob"oplam
PLaAfafd PfLL MH LMLY i COWUKMY TO AVM MAVB N PIgOHrq
TO THE INBPECM OF BUR DRM' '
The wml- owned hweby apples for a psm* to bulid a000rfftb Ow.toin
Owners Name D o R� s Ok l e f+e
Address d Phone (cl V A y 9 0 0
Afd*n 'a Name
Ad*M d Phone f ( 1
Iftnam-2 Name Codovy 13.ppINers
Address A Phase 13 Se w4 ( 478) - 1;Q-- 6 .l o
"IN N fw pmp an d OIIIdrpR ki S'd ea c e
Mood0l/drvv Woo . Faame Nadwaag forhwrw mI I 1
Ylla Oldldrq owdalla q ywy eS ue
Odbum ood `_ o O__gr lbwlrt• l7a�
d
Lfa. 1 /a G 3 5 nftft of Appl "
faNr�s uNofw rs f�lALIY•
ap pony m
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do herebycer* Ysder Paled and paimbla d pr1a>/a duo ,
1 am an anolorW povtdhas work@W coe'samd" cevspfs for my ogles sa wakb4 esl
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TRA�!eleR3 ?r�be,r�r+y eF rlfr„ars UQ • 87au7/8"�—(� 1
lauwana
1 sm a aok orepoleaar and hew me ens werithls fir ma Is MW o/eebe
C) 1 am a " ProP*lama general amusexor or homeowner (drds seas) and have lied Am
seetswCUM Read below wbo•bm Z14 followies wormW pp�b s PeNdsn
Contra= Inwwnss Der ry/*
Cows aer Intonnce Corsyawy/ o
Convaeur laawana Compaary/ iiadrer
O I am a homeowner Performing ell site work M"Wo
•I r.arrir arw a per d Sh AMMM a ea t«_ww ■oo Otan ii bmerawar of ee DIA ter C~ s1 a w41.las00 arler e.
�..argr a aea.0 use lariu 21n et PILL t f]sae was r nr weeria.of oietifsi eaeai seneMl
non wweuweel a,0 add&own w 0r ter"at$STOP WORK ORDER a"slow of a 100AC a eo aaetiw ar.
of c�-a b rti •1 s o'E
Signed t �G 1'� dry ////
ryV
.ietri3ct%fcnT111tee OYIIqcy'� g 'ePartn.sn[
�cczinl Eoare
Seleesmees Office
=ealeh Ge�armcr:
904 epc 405, 7?5
ruSuc rRvPMER1T UWARTMSMT
t So wtMNlNeroN Orman aRo FLOOR
i11LO1.eIAO)�
TIM.(276)7494N DeT.Sea
FAX (VM 74040"
STANrsrhur =' �' — -
IM
DOPOM OF DEM AFFIDAVIT
IS woardmoe wA dta p ovidow dMM a 4%041 aalmowrledp do r a oosdidas
ofm ft P'amit/- .td dabds m dit fhom as aaw&"m and ft
pvmad by dda BnDft Pa®it dd be ditpond offs s Prop*Scmaed wB w mb
dhposd heft,0 Mined by)AM a]pro
IOU"
/VoRtk s''c(e C A/L t.',v_g
The debdo w f li be disposed of at Ale , . (Yi A .
Locedaa a�tn�Faeft
otPmattAppliaaot Do"
FULLY campub dr hnow ing bhmedow
PUUB PRDIr L AIRLY)
LR;c PWO%eveR
Name ofPsmit Applfosoi
oi� Co(0N 4
Phis Nam%Vend►
3 Se-wAl1 s f•
PCAbv . (hA. 019(00
ddt Ac%Cray!Siaft
The above ataems requites do detris Am&a dmmoNdc%rmovaooq rehab or odw
dtaasias ofbml(t or stocum be A pond m a properfy4iotosed soBdwawe dirposd
fi cMly as def3sed by UM CUL SIMA.and On buDdms parmib or Bceoea ne so
iodfoass dr beadomi of ew he my.