7 BERUBE RD - BPA-2004-920 SHED DORMER fL s�rlbet�elE Pit
t OVED BY Tw # r
MARC dB D? P ' Ewa GRANTED
CITY OF SALEM
No. —�� l�� '. Dda
Is PrapolY Loaaad In Location of ✓l ft Hwodo Dbtft? YM_No_ Nd dioa
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BWLDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other•. Si' -j
PLEASE FILL OUT LEGIBLY 6 COMPLETELY TO AVOID DELAYS W PROCfttH NS
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the fo W&"
specifications:Owners Name I n(�tAev�- (VAe v)
Address A Phone -g2.rvio e K c( _ (q181 po I
Amhilect's Name
Address & Phone ;� ( 1
Mechanics Name ��i�Sig�� bu,�C(� 2�.�.ocl�� h I P1 64
Address & Phone ?to , Z6K "71) - (el-0
What Is rw puPaM it buNdYW
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Lie. / Lo s�L_ X : r,
` : Signature of Applicant
SIGNED UNDER THE
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OF PERJURY
DESCRIPTION OF WORK TO BE DgNE
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MAUL PERMIT D-V,l
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APPLICATION FOR
PERNaf TO
VIP
LOCATION n
PERMIT GRANTED
U/G l
INSPECTOR OF BUILDING ►.