14 WILLIAMS ST - BUILDING INSPECTION (4) -PL-*NS-MMiST-SEfiL{-G-ANO APPROVED 6Y T*IE
&S,PfXTOR PFWR T-D.A PERMIT 13FINO GRANTED
l \ — CITY OF SALEM
No \j�V
. Nam_,;. •� �'�� Date
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�p`�MINB�a
Is Property Located in \n Location of / I ( � n/f
the Historic District? Yes_No_ Building 1 ill y
Is Property Located in
the Conservation Area? Yes_No
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: Y�
Owner's Name A l 12 i `t c� o
Address & Phone aw �
Architect's Name
Address & Phone ( 1
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?
Estimated cost UD C) City License # N A siate License #_
_ Rome Improvement w
Lic. i18i6nature of Applicar1i
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTIO OF WO TO BE DONE
MAIL PERMITTO:'TDA-V )ID Mc-LoNal l
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APPLICATION FOR
PERMIT
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LOCATION
PERMIT GRANTED
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