284 Washington Street B-557-05 284 Washington Street Minor Interior Rennovation irL IB�Atl6i'�IEfIL�9�ND APPROVEO BY 774E
MPECM,PWR TD A PMW AMG GRANTED
CITY OF SALEM
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Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Rero1o_f,, Install Siding. Construct Deck, Shed, Pool, /
Ropair/Replace,Odw._jj;na r
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSM
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build aocorcL-V.to the following
speoilloations:
Owners Name D/bn lS L- Gam.✓
Address a Phone (Z 9�6- S YF 6 /C
Architect's Name
Address Q Phone -
%schanim Name �L hL/l l/ A
Address&Phone�a�T�/S e� SuJr9fiP���—g'�/77
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Signature of Applicant
SIGNED UNDER THE PENALTY'
OR PERJURY
DESCRIPTION
'� OF WORK TO BE DONE
11MIL PERMIT M.
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0 I am a sole proprfetora ssrseral conusuor or homeowner (ch omAe) and have bbW do
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Commune Insurance Comp ny/!eft N GM6"
Contracwr Insurance Comp&ny/?-Gky Nwnbelr
Contractor Insurance Company/Poky Nustaber
0 I am a homeowner perforating all the work myteff.
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