15 WILLSON - BUILDING INSPECTION "Plw*l"v-"fK&04mq APPROVED BY T44E
*AnnAlM=PGM TDA PEBWT BEING GRANTED
- CITY OF SALEM
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BWLDING PERWT APPLICATION FOR:
Per"tm
(Cinch % tidwwr apply) Roof. Rowd. In W Siding, Construct Deck, Shed, POoI.
RepawpAk9laoa, Otlwr:
PLEASE tall OLIT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BWLDING&
The wWwaiprwd hereby applaa for a pamUl to bWld according to the tok w N
Owners Noma
Addrou& Phorw ] ) La l y 7M 7 f Sr— I Z (d
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Address a Phone I y (Df� � sr L�ja,� (71l ) 5-1,. --7-5-i
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walla a tlrrlarlra L eS,r.arwrw.for taw Irrny tsmlws4 Si.)Z-,-ZE
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UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
5-6�
MAIL PERMIT rn ot-
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APPLICATION FOR
PERWT TO
LOCATION
PERMIT GRANTED
2Q
r—lW;OgROF
BUILDINGS