3 WITCH WAY - BPA �L11tNSiMIiST�E flLfD--AND APPROVEG By T*IE
,IdSPFCTPR PFWR TO A PERMIT WNG GRANTED
CITY OF SALEM
No. Date l/
Ward
.� Zoning District
Is Property Located in Location of ✓7
the Historic District? Yes No H� � s�C .d 2
Is Property Located in
the Conservation Area? Yes No
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/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
Address & Phone
Architect's Name
Address & Phone
Mechanics Name
Address & Phone f
What Is the purpose of building?
Materiel of bulding? If a dwelling,for how many families? _
Will building conform to law? Asbestos?
Estimated cost 0 0 D City License M state Licensees 0
Hasa Iaprovaent �l Lim
Lie. i
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
.t.
No��
APPLICATION FOR
PERMIT TO \
'- LOCATION
nRNIIT.GRANTED
APPR D
n/
INSPECTOR OF UILDINGS