17 VISTA AVE - BUILDING INSPECTION (2) r�
It:11kf!ISilffiT19E f1lL*G--AN0 APPROVEO BY T44E
-WSPfXTDA ,PFWA TD A PEANllT B,EWG GRANTED
1`\ CITY OF SALEM
�No. ` \JJ Date Q
Ward
��bmne ' Zoning District
Is Property Located in Location of
the Historic District? Yes No JC Building I AD
Is Property Located in
the Conservation Area? Yes_No JC
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replac , Other:
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
Address & Phone 2qq 15017
Architect's Name
Address & Phone )
Mechanics Name
Address & Phone ( )
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
0
Estimated cost City License• State U se #
Home Improvement
\VVV\`l Lic. i
Signature of Applicant
SIGNED UNDER THE ALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Igo e, CtQm e do0 r- Q nd nej2g - 6100 P C'
MAIL PERMIT TO: \ y l
1\
No. y�
APPLICATION FOR
PERMIT TO
LOCATION
-- I 111
PERMIT GRANTED
2 6 ID 19
APP /JOVFD
C"6��w�
INSPECTOR OF BUILDINGS
i
QTY OF SALVd
BMMU405 DFRARTNOM
HOMEOWNM UCOSE FJ�N1p'110N
Pleau pdd
DATE � -(D _Q •
JOBLOCATION olle
ADDREW
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PRESENT MAnV.G ADDRESS 30,01
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D>FnarsMOFHCNMJDW M
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farm swacwm A persat wbc consovcts alum than cane home ins two-ym V=W shalt not bt muddend
s homeowner. So&-hcnw cmTAe "sabndt to the BuDd%g OMCK CBS fw*W=Pu&k to tbs
Bw1dins OMe4 that WOw be uspomrbk w all NO&we*pafasraed toiler to boudbe permL
.The undasipW-b mwwax Rmvm respamSbift for c=pu=" the snit B>t Ming Code cad
otha applicable Sca by eva6 rules and icguiatiaoa
The wwknip W-hc wwm"acrasa lhat hdshe mudaris the Chy of Sak=B40mg D ffwvm".
minimum inspection pv=dwa and rcgimemums and ftt hhha will tampV wieb said pooedma sstd
lioMOWNER'S SIGNATURE
APPROVAL OF B=ING INSPEC70!(
$a otha sick for sate Code