29 WINTER ISLAND RD - BUILDING INSPECTION (2) fJANS M116T-SEffLf 1 APPROVED BY T44E
IW=DB .PPWR TD A PERMIT MUNG GRANTED
\ CITY OF_SALEM
Nob (\\V ` v '� `� Date 3; 9,�-05
s. .
Is Property Located In Location of
the Histoda District? Yee No f Building a9 U)44.e� Ss- 1el
Is Property Located in
dw Coriservadon Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: ePnnva-Fv bj<
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 \jnann e- Sim �-
Address & Phone 9 W 14 -25S /L! j91 -7 - yo b 8
' Architect's Name ri 0 0 rcA r�p
Address & Phone L 1
Mechanics Name r r) "O Goon IC'
Address & Phone ( 1
What Is the purpose of buiwirg? YP Aoya4-r o-Yl
Matedal of buk q? If a dwetkg,for how many famil ee?-1-
wla building conform to law? d os Asbestos? tl
Estimated cost'¢46, iT D C ty License• N k State License M
Improvezuent
Lie. if
ature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
R b
MAIL PERMIT TO: kolJ 72i C e uP I l yc�v
i
No. y v
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APPROV�D
w
IPtCTOR OF BUILDINGS
QTY OF SALFM
Bui DwriDEPARTiv M
liMaOWNEIL UCENSE E)MOMON
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HOMEOWNER'S SIGNATURE_C�G
APPROVAL OF BIWING TNSPECZ OR
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