15 GREEN STREET - BUILDING INSPECTION 15 GREEN STREET
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Plans must be filed and approved by the Inspector
prior to a permit being granted 3 S
No. [3� (� CITY OF SALEM Ward
HISTORIC DISTRICT? Y N ` Date
IF FOR SIDING, HAS ELECTRIC Home Phone - -
PERMIT BEEN OBTAINED? Y N Bus. Phone
APPLICATION '
FOR
PEBMIT TO
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TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications: c C
Owner's name and address —t Cq�/eQu� J � CL61
Architect's name
Builder's name
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Location of building, No. EEO
What is the purpose of building? c,J OLA,1 n L1
If dwelling, # of units? Material of bldng?
Will building conform to law? y s Asbestos? 7
Estimated costt$off City Lia.�f -7State Lic.If
Signature of Applicant
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SIGNED UNDER THE ANALTY OF PERJUR
DESCRIPTION OF WORE TO BE DONE
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Mail Permit to:
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No. 3�b� Ward
APPLICATION FOR
11 PERMIT TO ROOF
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REROOF OR INSTALL SIDING
Location
PERMIT GRANTED
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Approved
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