14 WITCH WAY - BUILDING JACKET "PI*MIAWIDE 1D APPR01/ED BY TIE
JWZC=P=R TD A PERMIT BEING GRANTED
CITY OF_SALEM
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Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Remf, Inter,Siding, Construct Deck, Shed, Pool,
Repair/Replace.
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build accor&q.to the following
specifications:
Owners Name -b A R2 i fv E-S� L LA
Address & Phone tTc 4 WA y ( 7�) '7 Ly U-CY109
ArchitecVs Name
Address & Phone f )
Mechanics Name T �N C b4 00c,'y - oM G E�dT
Address & Phone Jyfs
WO RC ES-MR- i
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Slgrtature of Applicant
SIMED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
INSTALL
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MAIL PERMIT TO: H ot,-t E t c-?O 1
7- f r aorz0 , M� o 19 79
No�
APPLICATION FOR
PERlW TO
� NSTALI- Ci3� 2EPL. l.UD� iv�a,,�S
LOCATION
L( W rrC H Lo A/
PERMIT GRANTED
APllibvFD
INSPECT OF BUILDINGS