6 BENGAL LN - BPA-2006-940 REPLACE 5 WINDOWS -Pj*NSilM*4EfILf- � APPROVED 8V T44E
A5p,CTDB'pMR TD A PERMIT .BEING GRANTED
CITY OF SALEM
�2/a 6
No. -,� Date _
•3
s: A
it
Is Property Located in Location of
Me Historic Dlstdd? Yes_No z/ >3ai �8 g�j p
is Property Located in D
to Coruervadon Area? Yes NO
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof of, Install Siding, Construct Deck, Shed, Pool,
paidReplace, ther:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name
Address & Phone t; Q � ��� f6- fix) 7qD— 2,2'S-
��Ie.r,.. �/7- o1F17o
Architect's Name
Address & Phone I )
Mechanics Name I"eI (et Cy��ws ��� 19 i-�Se
Address & Phone
whet Is Ow purpose of building?
Materfei of bukWV? If a dweling, for how many famMes?
WW building conform to law? Asbestos?
Edmated coat CRY Ucense e N A State U t?y8 3
Rome Loprover ent
r'i`' of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
S �Le,ol 4�w� c,��.�,•.�s
MAIL PERMIT TO: )- z M e�Ne(�
No. �
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
S/ t7l J S- 26
AP7 D
r
INSPECTOR OF BUILDINGS