5 BECKET ST - BPA-2006-137 ROOF S
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APPLICATION FOR
PEOW TO
LOCATION
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PERMIT GRANTED
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of
IN&PECTOWM BUILDINGS
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CITY OF SALEM
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BWLDINQ PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof a of, I SWN. Co WRW Deck, Shed, Pool,
Rs . Other
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCEBBMq
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build aowrdLV.to the following
specifications: ,r
Owner's Name U U
Address A Phone
Architect's Name
Address & Phone
Mechanics Name La t
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Address a Phone ?0 6 W �d ' �hch,�W
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whir is r»fa•Pom•it e,rbr,Y,
md"a baking? N a dwmlkq,for how many lamas?
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tom. .
/ J SW41urs of Applicant
6 8KiNED I1011DER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE # '
MAIL PERMIT TO:
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