9 1-2 ALBION ST - BUILDING INSPECTION No. 2 Zo o`-A
APPLICATION FOR
PERMIT TO
LOCATION,
PERMIT GRANTED
APPROVFD
INSPECTOR OF BUILDINGS
fMA"SIAOSTIBEfiL£�',4,PPROVED BY T+IE
WSPI:CTD.R ,PfflDfl TD A PEWT B,E1NG GRANTED
CITY OF SALEM
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2-No. LN 'ZOQ Date /
suety:. SS
\�rnnsr�' T
Is Property Located In Location of cy
the Historic District? Yes_No_ Building
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,
epair/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 —Tcc, -L0i,rk
Address & Phone � �a <��c�
Architect's Name
Address & Phone 1
Mechanics Name
Address & Phone
What is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost �DOU .6D City License# N A State tense #
Home Improvement
Lid. i X ignatu a of 4plicdht
I R 1 SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: �nnp� Y,�ti ZIS�♦� I� A\� .�c�5 S�\L s1