79 BEAVER ST - BPA-06-1017 ROOF k
fL111IBiAtltii�E fvAb4mD APPROVED BY T44E
affn=PLLIOR WA.PERW ACM GRANTED
CITY OF_SALEM
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BUILDING PERMIT APPLICATION F( R:
Pwmk to:
(Ckde whidwwr apply) Root. Rwoot, natall Siding, Corwtnu t Deck, Shod. Pool,
Other:
PLEASE IFILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
Ttw wWwaipned hmby applies for a permit to build according to the tollowmg
Owners Name S UA M S B i)
Addreaa a Phorw 7 c/ & A UER S-r
Ard*Wa Name
Address & Phew j 1
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Address a Phorw 3 / � �y/t/i/UG2S'�.Q j,NA 531-- o 9//
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we b A*q amronn to W? 9
Ealrwro Dort COO pqr 1Jouw r NIA our wa r O 8 D 3 93
rde. , o � e of Applicant
OVUM UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
mAL Pow To: LAUSTi ND M FL o 3/ �y}-
Na AO ZO
APPLICATION FOR
PER1/f TO
LOCATION
79 8 e —
PERMIT GRANTED
APP OV.��D / ^
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