19 1-2 WASHINGTON SQ N - BUILDING INSPECTION -PWMl MWT-6Ef#L{04rlr10 APPROVED BY T+IE
IW,WMM Pa= TD.A.PEI31#T=NG GRANTED
CITY OF SALEM
Date
Is Property Located In Location of
the Historic District? Yes No BU41Aing
Is Properly Located in
ft Coraervadon Area? Yee No�L
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, 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 tiC�
Address & Phone l47 1- i\J t9;&/)
dame
.Address & Phone j, 1
Mechanics Name
Address & Phone ( 1
what Is the r •� ('lT��
Momw o�"t ii .
Z4Z22 If a dwelling,for how many families?
Will building cordorm to law? Asbestos?
EstYnated cost City license• N p' lucer" M
Same Iaprov t
Lie. its
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
✓� S biz �� 71 Of &b lc �
MAIL PERMIT TO:
No. ycS1L�l�
APPLICATION FOR
PERMIT TO
T
LOCATION
PERMIT GRANTED
APPF�MFD ,
INSPECTOR OF BUILDINGS
01/07/1994 01:03 305-835-7098 ECONOMY TENT INT'L PAGE 01
3 'AwliT1�711'�L►
Certificate of , an�eewance
�,., REGISTERED
c.° APPLICATION ISSUED by
CONCERN No. CALIFORNIA COMBINING CORP. Date treated or
r : 5607 S. SANTA FE AVE. manufactured
LOS ANGELES, CA 90058 2-14-OS
qeT F419.01 ` I
This is to certify that the materials described on the reverse side hereof have been flame-
retardant treated (or are inherently nonflammable).
FOR Econoo
CITY Miami DDR 2995 NW 75ch Sc.
STA FL 33147
Certification is hereby made thatt (Check "a" or ,b',)
(a) The articles described on the reverse side of this Certificate have been treated with aflame-retardant
❑
_ chemical approved and registered by the State Fire Marshal and that the application of said
chemical was done in conformance with the laws of the State of California and the Rules and
Regulations of the State Fire Marshal.
Name of chemical used................... ----.••Chem. Reg. No.............
• Method of application-..................................................
- .----.....----
• (b) The articles described on the reverse side hereof are mode from a flame resistant fabric or material
registered and approved by the State Fire Marshal for such use.
Trade name of flame-resistant fabric or malarial used.
..........-TE% F419.01
Reg. No.. ....................
The Flame Retardant Process Used..WILL NOT... Be Removed B ``,
r (will w will n•t) Y Washing r
r �"^
' Y r
/1 1
Name pp otor or _ r•
!� of A lic Produmon SuperiMend•M �.By^'— �•-- — - --.. .. __ _ ~'
o;
+�►'4Et4t;�t• 1.a:41!� 1,( , <a r'tt• CONT OLLER
_.-._—. :. 1.. ,�:!>��".11�4t•.41'.:,►:::9P'.i!;Il.'.4�.'•.Il.',?
I�
01/07/1994 01:.03 305-835-7098 ECONOMY TENT INT'L PAGE 02
CONTROL NO. 2-14-05
CUSTOMER ORDER NO. Fax
CUSTOMER INVOICE NO.. 70817
YARDS OR QUANTITY- 12x100. 6x7o
COLOR White
STYLE_18-61
DATE PROCESSED