14 BECKFORD ST - B-2007-51 ROOF fL�11s1ANstqbEfRA94619 APPROVED BY THE
JMSPJ:DSOB PIWR IDA.PEBWt AWNG GRANTED
CITY OF_SALEM
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BULLDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever appy Roof f, Install Siding, Construct Dad*. Shed, Pool,
RapaidRoplace. Other:
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDING&-
The undoraipW hsrsW applies for a permit to build according to the following
specification-
Owner's Name
Address a Phew /`l /3�-�/�F • ��5�`��/ �Y�>>yo fs2y
Amhkods Name
Address 6 Phone ,p f
Mechanics Name (/mil' /cam✓
Address 6 Phons ) lf�t u,ad�
VAN is na pwv«•it WOW
mom a kow II a ONWq,for how many WOW
wo WA&V oowim to Iwo v
Erimwd aoa ;OWcsy umm• iV A a w*mww• O 7/6
wre of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTIONOF WORK TO BE DONE
/ iaa
MAIL PERMIT T0:
i
No. /DZ
APPLICATION FOR
PEFAffr TO
LOCATION
PERMIT D
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INSP6GTOR