9 ADAMS ST, BPA-06-746 SIDING, ROOFING n �
1
gIMSfe6 fIL-E�1D APPROVED BY T44E
I�LSPJ:CIL ,PWR TD A_PERMIT OfiNG GRANTED
CITY OF SALEM
3 !jG u G
Date
No. l'J 3 Location of
Is Property Located in Building
the Historic District? Yes_ No
Is Property Located in
the conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
.(Circle whichever apply) Roof, R oof In idi , 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:
/.�)Vall
Owner's Name
Sr
Address & Phone
Q /
Architect's Name
Address & Phone
Mechanics Name
r )
Address & Phone
What Is the purpose of building? f "�
Material of building? (^' °u If a dwelling, for how many families?
WIII building conform to law?
��-t, Asbestos? t�
Estimated cost G U o- u u CRY License x N A State License k
Same 7mpravaent X ��
Lie. l 11 Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
No.2� c m
APPLICATION FOR 1
PERMIT TO
over-
LOCATION
x '
PERMIT GRANTED
O J6 2.0
APPfibVfD
AV
INSPECT_ OF BUILDINGS