27 WISTERIA STREET- BPA C
-PL*fIS*MT-BE ftLf� ,APPROVED BY T44E
.IWP,PSTDR PWR TD A PEWT BEING GRANTED
CITY OF SALEM
Date
irz ..
Is Property Located In Location of
the Historic District? Yes_No_ Building c� G )1 � 6cl
Is Property located in
the conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) *49;00.1r
, Istall Siding, Construct Deck, Shed, Pool,
Other: CP/�/y7q lDgmg c'
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
Address & Phone . /(.4)i5/=ri'Q
Architect's Name
Address & Phone J )
Mechanics Name / ` '
Address & Phone
What is the purpose of buiidirxi? Qg r-4/1'1(�y( r
Materiel of btdlding? ! )Mel 1 If a dwelling,for how many families? �J
Nil bWlding cortonm to law? Asbestos?
Estimated cost Clty License r N r4 state License at l3
�\ Barge Improvement
Lic. 1 1
Ciiejature of Appp ant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�sL L C
MAIL PERMIT TO: _ 6
No.
APPLICATION FOR
PERMIT TO
4
LOCA�T/ION /
PERMIT GRANTED
3I
tc P r
APP VjFD
INSPECTOR OF BUILDINGS