16 VICTORY ROAD - BUILDING INSPECTION . �/
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Plans must be filed and approved by the Inspector Z-�Z— 7J
prior to a permit being granted
CITY OF SALEM
No. 84;'-C/� Ward
HISTORIC DISTRICT? Y N f Date—:AQ
IF FOR SIDING, HAS ELECTRIC +y Home Phone :7A11 1-c
PERMIT BEEN OBTAINED? Y N Bus. Phone
APPLICATION
FOR
+ PERMIT TO / G �+c�e�n ✓
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications:
Owner's name and address/„_Ap-,/ cc eileky r/ivIey ZG L//c%OP�i�GP
Architect's name [[TT lI 1
Builder's name
Location of building, No.j(0 �� l C:((9 n Il
What is the purpose of building? fl'e— Gk 0jV 1`700/—
If dwelling, // of units? Material of bldng?
Will building confo i tt 1Asbestos? n
Estimated cost 77 y it Lic.O/ State Y Lic.#
Signa of Appli ant /1
SIGNED -ER' THE PENA2Y OF PERJURY
DESCRIPTION DONE
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Mail Permit to: C �-j
No. 6 —�4( Ward
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location 16 v
PERMIT GRANTED
4eAA
Approved
J (4Bulldln to J