6 VICTORY RD - BUILDING INSPECTION (3) 1
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It.*MIdttlST19Ef L*D-A D A4)PROVED BY T44E
-LU3PEGTD-R .PFUOR TD A_PERMIT B,EW G GRANTED
CITY OF SALEM
No. y — � ` s *\I Date 7 —15'-0
Ward
Zoning District
Is Property Located In / Location of
the Historic District? Yes No V Building (o i JE�rio
Is Property Located in /
the Conservation Area? Yes No l/
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: V� G r�rCrG
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:�I
Owner's Name I mats
Address & Phone W78) �s-
Architect's Name
Address & Phone
Mechanics Name
Address & Phone
What Is the purpose of building?
Material of building? b)Oo9 If a dwelling,for how many families?
Will building conform to law? 7 PS Asbestos?— /DD
Estimated cost 6 O D J City License rf State License n 1
Bone Improvement `
Lic. If
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�cC --&,L^L9ATlor✓ 4— &LeVe G2:12 e
MAIL PERMIT TO: r!O ul CT XY K o Sa(Pt- 014?7o
No.vl - li
APPLICATION FOR
PERMIT TO
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Awe 62i/45e D��n tle
LOCATION "
PERMIT GRANTED
19
AP OV�D
INSPECTO OF BUILDINGS
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PAES&rMAII.INGADDRESS = V r L7a�
The eoaail,40,11 tlon Of-Umcowmn"was Mcade6,o lncbde owes Pfd dwnl/ep o[TWO
Ualts a kss and b allow snob homeow'nas to engsSe sn individsal.�sr bfa who does sol posses tt .
.pvvided tbsstha owma ad as overviva
DEF04TMCIFHOMEOWHM
Pens(s)wbc owns a peed of land on wbkb bdsbs resida cr$ueods to*es1d4 oa w ldeb there b,or b
intended to be,s one w two tank dwtUb 46 sssdsd of dwdrod trrtttnses accco t7 to nse4 tse=AAA
farm$W.KWes.A person Wbo=Strk=awre OM an lwme in a t9ool ar Period sbas sot be eonsldet"
s bnding o r. S*a L�rJsM be uspomb in suds wak pak"MA ����
BmldinS Osfx+al.
TM wW=iped-bomeowner-L%wm TcsPO7a lft for comPBW'ct w i8ttfie state Bntldha<Code tad
other appsabk goo by-laws,tales smd nplbdw&
The wwmipas)-bemeowne certifies Ltm hdshe woavands the ck7 of Sak=Bull ling Dew UNK.
. ntinimtas bopcW=proccd mes and regmau Cms and tint blsbe will eompl,with said Pcccftu ad
HOMEOWNER'S SIGNATURE �o
APPROVAL OF BI DING INSPECTOII
See other side for sou code