17 BENTLEY ST - BPA-2004-922 REMODEL KITCHEN & BATH 1 +.
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fI11N6illlb8*'BE IMPROVED BY T41E
WSP+ECIL�FI lQA D •E'MQ GRANTED �.
CITY OF SALEM
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BUILDING PERMIT APPLICATION FOR: 1
Permit to:
(Circle whichever apply) Root. Reroof, Install Siding, Constrict Deck, Shod, Pool,
RepaldReplace, Other. r1 I-r- �ew �-a A-I-h
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCWM"
TO THE INSPECTOR OF BUILDINGS:
The undersWW hereby applies for a permit to build according to the foibwing
specifications:
Owners Name �� &C- L/ Tf ►� y
Address & Phone / 2A e �4 S� 619) '72�k
Archkect's Name
Address & Phone f 1
Mechanics Name I� M c
Address & Phone 3 (y1 n�l�roF AV�
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Whd Is to papm it M~ it f:
Mrodal a1 buYdtg4 ail/o oC/ N a dlwlY g,for how nmy kmau? 1
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SION40 UNDER THE 109114",
OF PERJURY
DESCRIPTION OF WORK TO BE DONE c J
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MML PERMIT TO• 2cV�
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APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
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APP�Iov D
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INSPECTOR OF BUILDINGS
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