15-19 SABLE ROAD - BUILDING INSPECTION -�` I5-19 SABLEROAD
BY
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No. 153L•2
HASTINGS. MN
LOS ANGELES-CHICAGO-LOGAN.OH
McGREGOR,TX-LOCUST GROVE,GA
U.S.A.
Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM
No. ,, Ward
HISTORIC DISTRICT? Y �pv 9 Date 'F�-
IF FOR SIDING, HAS ELECTRIC • Home Phone
PERMIT BEEN OBTAINED? Y N Bus. Phone �96 �I
APPLICATION
Gi
PERMIT TO � a,3
� , y FOR
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications:
Owner's name and address
Architect's name
Builder's name G"�SA'V�AS � ���� •�a°'y- ,(/
Location of building, No.
What is the purpose of building?
�S
If dwelling, # of units? Material of bldng? wc4 H
Will building conform to law? 5, Asbestos? rf/d
Estimated cost / 4 2? City Lic.# ' State LVic.# Q �
Signature of Applicant `Q'QSQ Z
SIGNED UNDER THE PENALTY OF PERJURY
DESCRIPTION
OFWORK TO BE DONE
A / LA
j 1 Lin r (n
Mail Permit to:
No.563 -q 'f Ward /
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location
PERMIT GRANTED
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Approv
job B Idlnp Inspe or
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