14 WITCH WAY - BPA (002) any'h` d ��• , :.1 ,H
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fL1tNl3iNti6T`BE £ 4Nfl OVER BY 744E
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JAI:PF.CIL�A : lOJ3 D;31 P 11EMG GRANTED `
CITY OF SALEM
No Date
n Ir
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b Property Located in Location of \�(
ttw Historic District? Yak_No v/ Building
k Propedy Located In
tlw Coneervatlgn Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct,Deck, had Pool,
Repair/Replace, Other*
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCI1;8MO
TO THE INSPECTOR OF BUILDINGS: N
The undersigned hereby applies for a permit to build according to the following
specifications: ll I r 1
Owners Name 10 r✓r/I fi / a r e n G
Address & Phone I q W i A [Las Wh 7 N y- 6 76 9.
Architect's Name
Address & Phone - I
Mechanics Name
Address & Phone L 1
Wtwt Is ttw purpose of bMkq?
M"W of bWldinp? woodl i VI 4 c�C�/aglf a ft@ft,t«tww many ramVs#?----------
Will twildlnp cordorm to law?_V eS Asbeuos?_
EWmNed cost. City LkXM k fU P' a Str±
u INI
Ba.. Iapro�eaent ��
1--- XSignature of Applicant
SIGNED UNDER THE P11INAW
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAI PERMIT T 2
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iv s„ L O• t,.
y W4 Way ' "-'
APPLICATION FOR
PERMIT TO
S�t�O
LOCATION
PERMIT GRANTED
�4 0 y 2-0 '
AP OV f D
TN—SPECTOFf OF BUILDINGS
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