29 BALCOMB ST - BPA-2006-836 DECK jmL-*NS j"T.gE f4L*B-*ND APPROVED BY T44E
1UPECM PRIOR TD.A.PERMIT MING GRANTED
CITY OF SALEM
No.&Zzpd \ D11 y .
s:
Is wry Located in Location of �n
@a Historic District? Yss_No— Helldi"It C` dk
is Properly Loceted in
the Conseaatlon Area? Yw No
BUILDING PERMIT APPUCATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct D cc Shed, Pool,
Repair/Replace, Other: �-, «6,"efS
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 l Cf L' /vl 0�1'4�5
,Address & Phone a ��/ c S�.. (9?k) To- S«l6P
Architect's Name
Address & Phone f
Mechanics Name
Address & Phone If 1
What Is nw purpose of bulkift? ;I
,,// ec.- i /K�den ��MaWlel or bujav? �aj J/ /1? ff a dweWnp, for how many fam"s?
wW buUdlnq conform to law? /Y'PS Asbestos? 'f O
Estimated cost / a GfY UcW"r IJ A state e
Hoes inptovesnt
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
7 e S.e c o), 4 /—�40C, � �`�6/ , a/'
MAIL PERMIT TO:
No.
APPLICATION FOR
PERMIT TO
�OHy��e%IL � lrm�r dCc��
LOCATION.
PERMIT GRANTED
APP/ROVfD \
INSPECTOR F BUILDII4GS