1 BLOCK HOUSE SQ - BPA-744-2005 COLUMNS & PORCH RPR • �/ ` v
'PUMISIANTOEfiU41111 UD APPROVED BY IM
JMSPSCM PWR TXI A PERIWT BEING GRANTED
CITY OF SALEM
No. Dae
` R Ward /
Is Piopuly Looded in
IM FNdodc DWrid? YM_No_ D lon �f
�
Me CgMlelveegf AIMS VM NO
Permit to: R:
BUILDING PERMIT APPUCATION FO
(Circle whichever apply) I , nstall Siding, Construct Deck, Shed, Pool,
Repair/R Other
PLEASE FILL OUT LEGISLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build accordwig•to the following
specifkretions:
Owners Name .ate V i It ar-r��
Address 3 Phone /" /ac k l gnu,%-e � (9980 S 6 3 a, A
Architect's Name
Address & Phone 14
Mechanics Name
Address A Phone
wrw is sr purpose at buNtllle9 r P_vma cte 1,
MAN"a mow N a elwstNnp,for how merry ramNss4 _
wa ellrarg aanfonn to Wfl? �ad.aay
Esrnwad cost 3 CRY uo■Ise N Uo a 0 7&) q S S
es.e I>leo.Meae ¢
Signature of Applicant
SKDW UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�2rnave ea.;s rtfl c olcvwzsw ins // nP .l eolu:xs�s .co e porch .
thS�ali kand ra ; i -� b2iLki-er-S• T-jgs1-,t/( Vih4 / Sof t
_ y
hor cik .
MAIL PERMIT TO: L U Q V i I I r r ea-1 hoc l-�p`•
Salev,,, s9H 61976
APPLICATION FOR
APER W TO
AJ ,eb 06
PLACATION
PERMIT GRANTED
19
APPROVED
r
INSPECT
OR OF43UILDINGS