22 OSBORNE STREET - BUILDING INSPECTION x '22 Osborne
�i
(9 7 02op
Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM [[qq
No. LJ Ward
v�,Ecoeo�T,�i
HISTORIC DISTRICT? Y N Date
s
IF FOR SIDING, HAS ELECTRIC # Home Phone
PERMIT BEEN OBTAINED? Y N s � Bus. Phone—
APPLICATION
FOR
PERMIT TO / 11 1
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications:
Owner's name and address //) •� !/'17
n66nr uti2 ✓i
Architect's name
Builder's name
Location of building, No. //
�brJr» P Se
What is the purpose of building?
If dwelling, # of units? Material of bldng?
Will building conform to law? Asbestos?
Estimated Cost -Zl/ Cit4 Lic.# Statec.#
D a/7 ;2x)&,
H rovement L' ense # 44�L14
Signature of Applicant ��
SIGNEDUNDE�ENALTY OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Dki r L
n�l�• ter) �a
Mail Permit to:
Sa C Gt wss
No.-IYLq Ward
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location 2 Z C7
PERMIT GRANTED
19 9�
Approve
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