29 WINTER ISLAND RD - BUILDING INSPECTION (6) 'fLIM1046TIMEfIL1NkiliND APPROVED BY 744E
JMBPZCWB JPWH TO A.PI:BlIIT BEING GRANTED
���� CITY OF SALEM
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Is Property Locmmd In
the Carawrva*m AmW Yak.No
BUILDING PEIIMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Rawl, Install Sidktp, Construct Dock, Shed, Pool,
RspaidReplace. Other: 9 e rn oe(e i Acx 4-k�c c-5✓vi
PLEASE FILL OUT LEOWLY 44 COMPLETELY TO AVOID DELAYS N PROCESSING
TO THE INSPECTOR OF BUILDINGS: '•
The urtdweiprted hereby applies for a permit to build accartLig.to the.followinp
specifications:
Owner's Name -J oa n•g e &,e 4-+
Address A Phone aq 60, lsl"4 xej ( 4-s) -71/i-/evo
Architect's Name
Address A Phone ( )
Mechanics Name 5n1 c 7 c, r n r)
Address & Phone Hiddl v jc?, II ( 4kjn1
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Lie. 0 a®a a c,
re 6f Applicant
sIONED UNDER TILE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO` oo n/i e m 44-
02C' l�U,h z, -'s/e„-( e=L
5a NA 019-7o
APPLICATION FOR
PERIfT TO -
/��
P
LOCATION
�vA
PERMIT
, GRANTED
A77D
INSPECTOR OF BUILDINGS
CITY OP SAux
BURDING DEPARTMENT
HOtaOWIER LICENSE Eff1rt noN
Plan pdt
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TaEPHONS
PpzjiNT MAILNG ADORES: �--
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DEF24rK)H OF HOi fOWNW
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intended to be,a an to two LndV dwc0x&aaadted at deadod saueaua sCeMda7 to sae!Me tmdAsr
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HONMOWNER'S SIGNATURE
APPROVAL OF BMDING 1NSPEC7OR
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j-jo EOWNER'S EXEMPTION
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