0094 WASHINGTON SQUARE EAST - BPA-06-319 Sao
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1i.11f/ IdUST-BE f1i.{-9--ArN0 AfPROVED By T44E
ApIS,P,FXTDB,PRIOR TDA PERMIT BANG GRANTED
CITY OF SALEM
No. 3 'y �� Date
CT�"�^
it.
Is Property Located in Location of
the Historic District? Yes_No Building
Is Property Located in
the Conservation Area? Yak_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof er Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, 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 t<-VJN�
Address & Phone
Architect's Name A
Address & Phone ( )
Mechanics Name
Address & Phone — K�0'6
What is the purpose of building?
Material of building? ZPQ m k If a dwelling,for how many families? hT
Will building conform to law? 41CA Asbestos?
Estimated cost city License N N A state License at csmc 1
Hone Improveaatnt
Lit. i 1
Signatu of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: \'F.O NV,, D
No.,
APPLICATION FOR
PERMIT TO
'ZP�
LOCATION
PERMIT GRANTED
2.0 r.
AP ROVED
INSPECTOA OF BUILDINGS
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