2 ADAMS ST - BUILDING INSPECTION (3) i v '
4PLIMIANTM fIIlB#ND APPROYEO BY THE
JWPECMFJ,PWR TD A PERMIT BEING GRANTED
CITY OF_SALEM I1 _
No. aM 1
` Ward
is Plopely Loaded M Location of
he a ktx DMrW? Yss No— >sai]dins \�M�
Is Pmpwfy Loaded In
Oo C ONVOlon Am? Yak_No_\\
Permit to: BUILDM PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Dad , Shed, Pool,
Repair/Replace, Other.
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROCESSM
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accortLig.to the folbwing
specifications:
Owner's Name vt C� J6,e,
Address 3 Phone 2 A �A WI S S'r (9?q I ?W 3�(3 9
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( 1
What Is Me purpose of b~
mom of buldlnp? M a dwafYrq,for how mmy%nlasa?
ws buNd ft onnlonn to hm? Asbe"?
Edknatad oadJ� 0 0 o d Cfly uomss• efaM uo r
sots Tsleoo�aat
Lie.
Sliniture of Applicant
SKINED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: �^�
NO.
APPLICATION FOR
PERVT TO
LOCATION
PERMIT GRANTED
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INSPECTOR BUILDINGS
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