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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED L
Location of Building i ST
Building Permit Application For
'(Circle whichever applies) Roof,Reroof, install Siding,Conshuct Deck, Shed, Pool '
Additio teratioe4 paidReplace,Foundation Only, Wrecking
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Bui►dings:
The mWerag ed hefty applies fora permit to build according to the following specifications;
Owners Name Lv Contractor. .,
SoeetJ il(l t.,2le_ , a-✓-& - City Shfet S{ lit),
Stain Phone State Phaoe(�I�'1_S4�
Architect: ✓a ( Q$��¢ cEo1 �l o �tt4 City of Salem Lktt
Street S VWW I at� City State Lich a, O HIP M ►7 < Q q q-
State Wes_ Phone 0%) Zt —443 Homeoween Exempt Formes ao
Stmcwre: (please circle) Single Family, Multi Family# '7— Other
Estimatfd Cost of job$ 0 p
Will building confirm to fir! Ano
so
Description of wont lto/b done:
Drawings itted: no Mail Permit to.
X D192q
Si re of APp��,$ NED UNDER THE PENALTY OF PEfUURY
CONSTRUCTION TO B 'k OMPLETED WITHIN SIX MONTIIS OF PERMIT ISSUED DATE
Depattaxot use oni Pennj`'Y Zoning
Permit fee i
COlIIMATS:
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