77 BEAVER ST - BPA-2005-144 SIDING, ROOFING 1"NSIMT19EIRLV54AD APPROVED BY T44E
I y ASPECM0 PRIOR TD A'pEamrr BEWG GRANTED
CITY OF SALEM
No. JDals -�y
\ rI ward
Zoning oistdci
Is Peomiy LocaEa-' in ldedeion of
the Historic DWdct't Yaa No `� aailddna �}
Is AaMly Lorded in
ftn Co mervedon Area? Yes No V
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) R R Install Idin Construct Deck, Shed, Pool,
Repair ce, 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 accomkig.to the.followhlg
specifications:
Owner's Name Be
Address & Phone 310 L RR
77 IZALZIR S
APhone ( )
Mechanics Name
Address A Phone 30
Wha Is the purpose a txdldkrg9 ,,k
mammi a i>tlld W nka c/( Ir a dwelling,for how mmy famaea4
Will arlti ft confonrr to law? Admtos7
EalMnatad coat 3�Oo °�' qty Licarw a She Ucerr»N � 3i
Rom improve�t
Lie. I
S re of ApO icant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
61
MAIL PERMIT TO: 7� /�ev�� S/fIQ•h /h ,
' I
os
APPLICATION FOR
PERMT TO
LOCA71 .
PERMIT GRANTED
i
�D
�h �
INSPECT OF BUILDINGS
Yam'
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