6 ANDOVER ST - BPA-06-361 REMODEL 1ST FL BATH -PLAINSIdWT13Ef11W- tf1D APPROVED BY T+IE
JWXZIW PRIOR TD.A.PEBANT BEING GRANTED
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/l� CITY OF_SALEM
ZY,No. 14� '� Date O Z J
Is Property Located In Location of
the Historic DLstdct? Yes No— Building
Is Property Located in
the Cmdervedon Area? Yes_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repa/Rat we, 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:
Owners Name N.<4D/Qt
Address & Phone OW) was= 9 D 6
Architect's Name
.Address & Phone If )
Mechanics Named
Address & Phone
wn ✓��r
Whet Is the purpose of building? r
Materiel of buYdirtg? If a dweYing,for tow many families? J
WIII blalding conform to law? Asbestos?
Eaftated coat 9'.ass. Gty license a N k State Ucertse r
/V.°O Mena Laprovenent
Lie. i/D7t S`ff
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCCRIPTION OF WORK TO BE/ DONE y/J
//t_.—C✓L.m R�C / �Q �/ is oc� � �� / /d
MAIL PERMIT TO:1121 �.� l�is ✓ e —r_ 11Z4
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No.
APPLICATION FOR
!J PE
RMI
T TO
LOCATION
PERMIT GRANTED
.z, 10 O 5'
APPROVED
L 4.
ECTOR OF UILDINGS
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