6 BARTON ST - BPA-2005-158 DECK fL�N6IM W13EflLf941019 APPROVED $Y ti1E
ASPSCMR PRIGA TD A PEHIW BEING GRANTED
CITY OF_SALEM /
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Is PrOPINtY Located
Uw Mhtorw DWdd?� Yea—No sallesna loin of6 �r
Is Acpaly Located In /
00 C servalfon Area? Yea No v
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Dell,\ Shed, Pool,
Repair/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 accord-ig:to the following
specifications:
Owners Name p, Q 0 tq"v C� `✓. - c
Address & Phone / ( 52<h �IL/
Architect's Name
Address 6 Phone t
Mechanics Name 14 w CIO N„ �g
Address A Phone
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A ftw of wow N a dwaft for how m"families? r
WIN bAding conform to taw? 44,6s Aabaatos? 'Ft/
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Silp lure of Apo icant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: 'To C`f e1v
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APPLICATION FOR
PERII<T TO
Cmor
LOCATION
PERMIT GRANTED
19
APP,ROVFD
INSPECTOR IM BUILDINGS
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CrrY OF SALEM
BUIMING DEPARTMENT
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HOMEOWNM'S SIGNATURE
APPROVAL OF BDING INSPECTOR VII
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HOMEOWNER'S EXEMPTION
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