0025 WASHINGTON SQUARE NORTH - BPA-04-98 i
DATE:
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Building Permit Application For: ��,,„„,,,,�,
Location of Building "^'�3/&f '/7 / So /tl
'(Circle whichever applies) Roof, Reroof• Install Siding, Construct Deck, Shed, Pool
Addition Alteration Repatr/Re lace oundation Only, Wrecking
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:
Owners Name_ i/ ��J„/y� Contractor: b"J!S O(dx-- 51 jsSE
Street J��"Sy�1S 1_ SQ �/d2 City S�y� wv Street F 4rklW,r Af,6 City S-A-16t
State,, y• Phone ( ) State Phone(`/>Sl) 969— 3a60
Architects: / 015' City of Salem Lic#
Street City StateLic# 0 6ySSHiP# f 3/ 53 K
State Phone ( ) Homeowners Exempt Form __yes no
Structure: (please circle ingle Fatni Multi Family# Other
Estimated Cost of job Slkwm0
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Will building confirm to law? yes yes no
Asbestos?des i✓no
Description of work to be done: AA ZeM' AIF, /,-/ihtL✓ g xE
Drawings Submitted: es__Z no Mail Permit to:
X L/A� X— Ayz
Signiture ot Application,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# J, \_v�oning Map/Lot
Permit fee S
COHMHPTS:
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No ��J
APPLICATION FOR
'PERMIT TO
IZ/o�Ki
LOCATION
PE MIT GRANTED
APPgOVFp •.
INSPECTO • OF BUILDINGS w
CERTIFICATE OF OCCUPANCY rt
YES
NO �-
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