4A ARNOLD DR - BPA-206-947 REPAIR DECK � t
g T-BE{IL99 AND APPROVED By TiiE
om4%pJ:CSLIB PRIGR TOA.PF.AWT AEINO GRANTED
CITY OF SAI.EM
No. \
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to ply Located in Location of H /7r �✓
to tiicwdc DIgd s G? Ye No _ Building
is ftw"Locam in
an Carwradon Ana? Ye_No_,
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof. R f, Install Siding, Construct Deck, Shed, Pool,
/Replace, Other-
PLEASE FILL OUT LEGIBLY i 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
Address & Phone 119 a3-4-1 S 1
Architect's Name )LI //
Address & Phone f 1
Mechanics Name
Address & Phone 1F,
whu is ih.putpoca a twrdrq? 5,.,;,. F �..: i�
www a txridirp? d a dW WQ,for taw many Ism6"?
WW bWkk*Wda(M to low? Anrnoe? IV ,
EWWWW con CRY their.a IJ A Slate Licence e
Ems laprawerant
r v V Lit. ff X
S' nature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESC4'dIPr,ON OF WORK TO BE DONE
MAIL PERMIT TO: � it
No.
APPLICATION FOR
PERWT T�/O
/�/�
/ ` l iter !i ej
LOCATION.
PERMIT GRANTED
1���2.o
APP VfD
INSPECTOR OF BUILDINGS
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