25 BENGAL LN - BPA-2005-152 REPLACE 3 WINDOWS 4Pt MN6MWT9EfIL404AD APPROVED BY 774E
ASPE=8 PWR TO A.PERMIT BMG GMwtD
I CITY OF_SALEM
No\�� o \ Data
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s '
rt x. arc Ward
\ f ZonNq Diatm
Is PmPwty Located
Iha WISED lc Dbtdct?b Yw No Location of
Is RoMty Locided in
ftCauarvadonANN? YN NO
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Remof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a Permit to wild accordwig.to the following
specifications: / /
Owner's Name "—� � 2� c vY'h , 06 L6 /CSC
Address & Phone / / ��� �7 —2 v
Architect's Name
Address & Phone L If
Mechanics Name 7
Address & Phone
was a nt.pupoa.of tKdlaw,p? C e 2 &k �
m"m of buldng? 1■dweb ,for taw mmy famgm?
WIN bLm q conform to low? AabasloaT
ErinWad coat �City man"a a_
mamm
Signature of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
7D OF WORK TO BE DONE
r 7 L-e
MAIL PERMIT TO: /LE11,g,7 n7 p
-719
•t
No.�
APPLICATION FOR
g� PE/RWT TO
LOCATION
PERMIT GRANTED
19
AP �D
INSPECTOR OF BUILDINGS