4 BLANEY ST - BPA-2004-304 ROOF, SIDING, GUTTERS -PL-*m Mtj BE ffL-E� APPROVED BY T44E
,=PxTD-j-3 ,PF.uDR ID A.PEAIIIIIT I3,EWG GRANTED
CITY OF SALEM
�.UNor /
No. J 2-00t.-( •\, Date
.�'cYMIN6�� T
Is Property Located in Location of �
the Historic District? Yes_No�4 Building 4 joA6 -W
Is Property Located in CAL
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to: ,�)
(Circle whichever appl Roo Reroof, Install idin� Construct k Shed, Pool,
epair/ Other: del.¢
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 92X Sd�K ''3 ?eV
Architect's Name
Address & Phone j 1
Mechanics Name
Address & Phone
What is the purpose of building? ll�C�J
Material of building? [ If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost GTV9 City License# N A State License #
Home Improvement
�'Z-O�uGPSI-e c. i
Signature of Al t
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
/e4GyC 6,�Z7Tzr.� ' 132a� ! Phi cYa�
S/c1J/nl(� �c�912 � � 4�n� Q.QInL 4�4 rGx?�e�
I 1
MAIL PERMIT TO: ( J(/j
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APPFj fD ,
G��
INSPECTOR Of BUILDINGS
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