2 WISTERIA ST - BPA APpI ICATTION FOR
PEAW TO
LOCATION
pE MIT GRANTED
19
np ov a
INSPECTOR BUILpINGS
CERTIFICATE OF OCCUPANCY '
YES
NO � ' �
DATE: 5 a 7 Q Y
Citp Df `�' afp i, �Ra5E;ar JU'5Ett5
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED L L
Location of Building � VV 1 slerl —
Building Permit Application For:
Circle whichever applies) Roof, Reroo iding, Construct Deck, Shed, Pool
Addition, terati epair/Replace, Foundation Only, Wrecking
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:
Owners Name. 7n/ 4 Contractor: Cnri stnnnPr Zorn;
Street in• Street 11 5 North qt-rPPt City_ga1 m
State Phone (�9) `7/pa -7110 State MA Phone (978) 741-0424
Architect: City of Salem Lic# 1405
Street Citv State Lir#0 5 7 7 3 3 HIP# 101609
State Phone ( ) _ Homeowners Exempt Form_yes�no
Structure: (please circle) Single Family, ulti Family# Other
Estimated Cost of job $ f��—
Will building confirm to law?-yes no
Asbestos?_yes v7no Description of work to be done: _ SL 1l O SQ i areS f
SERVICES
Drawl? es no Mail Permit to: 1.15 NORTH STREET
% c'Ar.Em MA 9s97®
Signature of pplica n, SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# Zoning Map/Lot
Permit fee$
COMMENTS: