5 WITCH WAY - BPA ti
iat�l{QSirtFliS9 9£fH.E �idO "APPROVED BY T44E
II �CTL PIJpA TP / P.EAIIJT]BEING GRANTED
CITY OF SpLEM
No., 1 T� -2-OOtf �� "� �� r ` Date U41
Is Property Located In Location of �^ /
the Historic District? Yes_No I/ Building
Is Property Located in �1[
the Conservation Area? Yes_No U�\
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, ol,
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: I/
Owner's Name I )e'^Vj,s R h
Address & Phone
Architect's Name
Address & Phone ( 1
Mechanics Name 4
Address & Phone ( )
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost gVDW City License N N A State License N
tfom rmprovesant _z /C
Lie. /
t Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF/WORK TO BE DONE
'YN'YJOVCIV
MAIL PERMIT TO:
s
No.. 317-20op
APPLICATION FOR
PERMIT TO
LOCAT[01
PERMIT;GRANTED
eXn-40 19
APPp(NFD
INSPECTOR F BUILDING