34 WEBB - BUILDING INSPECTION XJ0
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DATE:
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
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Building Permit Application For: Location of Building 3 �
'(Circle whichever applies) Roof,Remof• Install Siding,Construct Deck,Slum Pool '
Addition, Alteration, Repair/Replace,Foundation Only, Wrecking
Other t�rVh> F
PLEASE FELL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies for.2 permit to build"rdimg to the following ssppecificationc
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Owaeri Name: Nat,N �c�` f� Contractor �i M el,
—but 3 / t7el Sli. city Sr\lP/! street P Rivervier,., ;4,@ , O�,ivers
State/}la. Phone G7�)_375-a-? 73 SwI2.c�. Ph=(g78 ) 37 73
Arcbiteet: City of Salem Liek lly
Street cit state the c7oa��7 BPr 1-�8(P3-�
state phone( ) Homeowners Ertempt Form_yes no
Strvcwre:(please circle) Single Family, Multi Family N_7_other
Estimated Coat of Job S
Will building confirm to IaN?_I/_yu no Jv`t
Asbeaoat_yes ✓no
Dacriptian of wornto be doneiz r uc� r\
Drawings Submitted:_y no Mail Pe to: L
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Sipawre of Application.$ GNED UNDER TIIE,.,.,,LTY ,PZLIURY DrN ve
CONSTRUCTION T B p�LETEp WITHIN SEK MONTHS OF PERMI ISSUED DATE
Department use only: Perml!/ Zorting Map/L of
Permit fee f
CONGMTS:
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