9 WINTER ISLAND RD - BUILDING INSPECTION (2) 13L*W MU T-BE ffL-ED-*N It APPROVED BY T*IE
JI RIXTOR PWDR Tp A.PERMIT BEING GRANTED
_ CITY OF SALEM 9
NO\� Date
Ward
NE W Zoning District
Is Property Located in Location of
the Historic District? Yes_No_ Building 1&t Aler
Is Property Located in ! —
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof. .6eroof, Install Siding, Construct Deck, Shed, Pool,
epair/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 Ayttt2 /'ems
Address & Phone 9 41-(44t- Nced 'EDI . (l79 ) �)Y5- 665 6
Architect's Name
Address & Phone ( )
Mechanics Name P-964 ojou/S
Address & Phone � r-p�.t
What is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
0.
Estimated cost ��� City License# State License# �l8y3
Rome II� rovement Lic. IIZ9 7
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE MAIL PERMIT TO: �G%(/!'hC
.t
EAL(No. v J
APPLICATION FOR
PERMIT TO
n Ince
LOCATION
1 4wl? der Z4-d am
PERMIT GRANTED
19
AmPROVFD
INSPEC OR OF BUILDINGS
i