0003 BARNES AVENYE- BPA-5-309 SIDING gPLAIlt1SI111bST9EfKA"Ag APPROVED BY T44E
J UPJ:CM PRIOR TD A PEi MIT BEING GRANTED
1\\ CITY OF_SALEM
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Is Propwty laeaDad in
Location of
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Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Remof, Instal Siding, Construct Deck, Shed, Pool,
Repair/Replace, Oth
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accor&,vg•to the following
specifications:
Owner's Name S C-T-+ 45
Address 6 Phone "D MES Aye 6?6 Sq y-
Architect's Name
Address & Phone ( l
Mechanics Name ���N eH �i HmM c
Address & Phone �`/5 �rz c=�r.�w o v� ST (q-)�&l 2SI 9-5-7 L G
Wtmt Is to purpoaa it L11dI W
mdWII I of bulldrg7 ff a dweb for tow mmy famWa4
wa hmOv col"n�n to law? AaDaatos4
Esftm d coal ` i 000 (ply Llcer"a Stals Lim"a
Hama Improvement �
Lic. / 12(e 5 53
Signature of Appioant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
INST-AL,L- l � SQ J, xjyL S I �I � 6-
MAIL PERMIT T / It,
U
.t.
No
APPLICATION FOR
PERIIfT TO
LOCATION
Ae�
PERMIT GRANTED
t9
AP t
INSPECTOR OF BUILDINGS