26 BOARDMAN ST - BPA-2005-235 WINDOWS '*L11NSiMtlST19EfiL&ROAD APPROVED BY 774E
JdSMIMIR POW TO A PERMIT BEING GRANTED
CITY OF_SALEM
No. — \ Data
\ I Ward
za" Diana
Is ftpmY Located In Location of
the Mletonc District? Yw No fleildina p7G �jr�,,��tsiC�u S
Is Ropsrry Locabd In
Ua Carrsentlon Mat? Yes No
BUILDING PERMIT APPLICATION FOR:
Perk to:
(Circle whichever apply) Install Siding, Construct Deck, Shed, Pool,
epair/Replace. er:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accortmg.to the following
specifications: /1
Owners Name ec, '-E
Address & Phone Wz) 94fD—o? 9�1e3
Architect's Name 1e0SO
Address & Phone ( 1
Mechanics Name
Address & Phone /(
What Is to purpose cf buHdW
A dww of buNdrrp? If a dwaflkrg,for how n my fmnaes? Z_
Wa- 11-12rq carrionn to law? Mibeatos?
Erimated cost Clty L cwm a z
smaLie.
Uc«re
Lie Igrvese°t
. i 1:c
Signature of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: .L-
No.
APPLICATION FOR
PERT TO
L �ON
PERMIT GRANTED 1
�� 3/ lD✓� 19
AP !/( VFD
✓N IK'O
IW9PECT0RVF BUILDINGS
Y•
" 1.