225 NORTH STREET - BUILDING INSPECTION Y
a �.5� � ��
I
NO. 153L
HAsTING5. MN-LOS ANGELES
LOGAN ON-MCGREGOR. TX U S. A.
No!� j Ward_
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location
P RMIT GRANTED
19
Approve
Q co• ( B ' ' g Ins for
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Plans must be riled and approved by the Inspector before a permit will be granted.
City of Salem Ward
IS PROPERTY LOCATED IN THE
HISTORIC DISTRICT? Yes_No6�! � a
IF SIDING, HAS ELECTRICAL Home Phone #
PERMIT BEEN OBTAINED? Yes No
APPLICATION Bus. Phone # ��lSl/ 7G7
PERMIT TO ROO , REROO OR INSTALL SIDING
Salem, ass.,
TO THE INSPECTOR OF BUILDINGS:
The undersigned herebv applies for a permit to build according to the fo owing cifi a[ions:
Owner's name and address 4o/ e /liC/le� _ aaz.s'✓�/ 5•/ L�""`
Architect's name
Mechanic's name and address
Location of building,No.
What is the purpose of building?
Material of building? Asbestos?
If a dwelling,for how many families'-
Will
amilies?_Will the building conform to the requirements of the la%?
Estimated cost —31 92173-6 0 Contractors Lie.No.
Signature of applicant
REMARKS SIGNED UNDER THE
PENALTY OF PERJURY.