12 WINTHROP STREET - BUILDING INSPECTIONI C
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.►AISPE&T',DR ,PRWfl TD.A_PEB MIT.BZING GRANTED
CITY OF SALEM J
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No. �\. Date
Is Property Located In Location of
the Historic District? Yes_No JZ Building I) �hroo
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name
Address & Phone I;n �r��. 1.aI�= 01% ) R-1 - raR
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What is the purpose of building?ALL Sl D C— "C .1
Material of building? If a dwelling, for how many families? 7
Will building conform to law? alp
Asbestos? Ljy\� 61MVA
Estimated cost—City License # N A State License #
Home Improvement
Lic. 1— X —= , z�
Signal re of ApplicYnt
SIGNED UNDER THE PE TY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT T0:
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$6 peat swo 0D"D
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APPLICATION FOR
PERMIT TO
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LOCATION.,
a
PERMIT GRANTED
Lo 2.0
AP OVfD
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INSPECTOR 6F BUILD GS
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Living room
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Bath a Dining room
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