0 BAKERS ISLAND - LOT 41 - BUILDING INSPECTION Baker's Island Lot 4141
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Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM
No. C� Ward
HISTORIC DISTRICT? Y N Date a`
IF FOR SIDING, HAS ELECTRIC '+ Home Phone
PERMIT BEEN OBTAINED? Y N Bus. Phone 'mak
APPLICATION
FORrYt
PERMIT TO `
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the.-
following
he_following specifications:
Owner's name and address
Gi arm= �h��
Architect's name JY
Builder's name
Location of building, No.
,.
What is the purpose of building?
If dwelling, # of units? Material of bldng? LL70o� y .v
Will building conform to law? ks Asbestos? 1Q)
Estimated cost 150 Q O o City Linc.S State Lic.#
Signature of Applicant
SIGNED UNDER THE PENALTY OF PELMY---
DESCRIPTION OF WORK TO BE DONE
Mail Permit to: /, 7� /J / /J/�� 5 �i//J� L2�
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Ell, N 11111"',
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41
WardNo. wa
APPLICATION FOR
PERMIT TO ROOF
. , ' '11 13 ' ' 1-i ,
REROOF OR INSTILL ibik
Location
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PERMIT dkAN"TiED
C/
roved
BUIlding Inspector
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