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Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM
No. Ward , (R/
HISTORIC DISTRICT? Y N „ Date M-5 -
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PERMIT BEEN OBTAINED? Y N Bus. Phone�6iY� Sal �3ro
APPLICATION
FOR
PERMIT TO Nc RR�� RN EX 1ST rk1G S1g6-6
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications:
Owner's name and address F-P-AIJ C �. JUbSON
Architect's name &)D
Builder's name
7,PdJl EL JL)os'd✓Ll
Location of building, No. 144P�j7 4-67 � J�A,rc 4 / d
What is the purpose of building? S—f0P-hgE SI¢c
If dwelling, # of units? ld/,4 Material of bldng? Wo6 b
Will building conform to law? XE 5 Asbestos? Nr2
Estimated cost #7w , C7o City Lic.# State Lic.#
Signature of Applicant ��� (� ,
SIGNED UNDER TfiEv PENALTY OF PERJURY
DESCRIPTION OF WORE TO BE DONE
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Mail Permit to:
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No. ' -�� ward /
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location M,Q pl-tl 1" 7,7 :B a,tNQ4-s
PERMIT GRANTED
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Approved
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