79 BOSTON - BPA-2005-752 SIDING fEA}t jWST-9E fIL£� APPROVED BY T44E
1N&pECTDF.I PRIDR TD A PERI,pET 1kMG GRANTED
CITY OF SA\LEM
No.`s y \ Date
y��yu
is Property Located in Location of �7 �o
UM Historic District? Yee No Building 5 on
Is Property Located in
r tlw Conservation Areal Yea No,>_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Rero Install Sid' onstruct Deck, Shed, Pool,
Repair/Rep r
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:
Owners Name
Address & Phone j�aP ) �Yf o�OS_
Architect's Name
Address & Phone
Mechanics Name c1 '
Address & Phone l
What is the purpose of buikfing?
Malarial of building? WOA3 B a dwe",for how many families?
WM b Adding coreomr to law? Asbestos?
EsfYneted cost 3 SW_ Gty License• N �' Ste snee e (iliK G G y
Bone Improvement
Lie. !
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO.BE DONE
t
MAIL PERMIT TO: X t�1
APPLICATION FOR
PER1/T/TO
-T
LOCATION
PERMIT GRANTED
3z/PZ0 �b
� AP O D
INSPECTOR DF BUILDINGS