4 BLANEY ST - BPA-2006-737 RENO 5 UNIT BLDG ` i+4.1M?Sil7liST- EffL{G-4*0 AffaROVED BY T*IE
W5pirCT0-R ,PWFI TPA PERMIT.Bf NG GRANTED
CITY OF SALEM
Date
No.
Is Property Located in Location of
/dN
the Historic District? Yes_No_ Building
Is Property Located in
the Conservation Area? Yes No (/
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) eepair/Re
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tt D� Sf��Pool,
I Other
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: n
Owner's Name
Address & Phone $' h
Architect's Name 6-jokc5tzl—
Address & Phone
Mechanics NameL
Address & Phone �� A-kAT- Vl N/t,(, , �1
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What Is the purpose of building?
Material of building? (4bvl -k ,Lc If a dwelling,for how manyfamilies?
Will building conform to law?_
G Asbestos? Y� `Z
Estimated cost —�_ 3 a
ooa o� City License # N A State License # O
Home impr� nt -
Li°' I ` Signs a of Appli ant
.SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE 1
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MAIL PERMIT TO:
.1.
1
No.
APPLICATION FOR
PERMIT TO
(A°a' �e,�� z\
f
LOCATION
i
PERMIT GRANTED
2.0
APP OVFD
INSPECTOR OF BUILDINGS
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