0005 BERRYWOOD LN - BPA-2004-315 PORCH er
SAS -BEfiL{-13- AfPROVED BY 741E
F jUS,PZ� CJLfRPM0RTD"A.PEBMT.I3,EWGGRANTED
CITY OF SALEM
No. 3/S" 200i� Date
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Is Property Located In Location of S
the Historic District? Yes_No Building LC/
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, ed, , Pool,
Repair/Replace, Other: TTI cry" it
01
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 `t l�1+h 5f L�.�f� q Frcee r
Address & Phone ,15,8er(�1l.cX.)od Ln (J76) 7L/1-/ Ct q q d
Architect's Name R6Ci e I' uGh e r
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What is the purpose of building? ck 6 (C
Material of building? \ If a dwelling, for how many families?
Will building conform to law? yP S Asbestos? h r5
Cn
N q U
Estimated co��.xl0 ��ity License # _State Li nse # 8
Home Imp ement
Lic.
GK 2? (0 7pp gnature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
gl�u F' gix 6 I -FQ(m-lf S ,porch cF- y-E . ff-e,2 C�d .
(A)14-A roo-4�: Mend-Qd and 2_ ccl G(mn_S
MAIL PERMIT TO: KQ4A t L(sq 5Cfkr
1
No.
APPLICATION FOR
PERMIT TO n
LOCATION.
PERMIT GRANTED
2-0
AP V�D a
INSPECTOR OF BUILDINGS .`
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13 La
114
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