83 BOSTON ST - BPA-2004-878 REMODEL KITCHEN t• h
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INCRFr_T� i .pURBE rs GRANTED
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0 \ \ CITY OF SALEM r/
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof Reroof, Install Siding, Construct.Deck, Shed, Pool,
RepaiNReplarre, thee.
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESM18
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the folk►wing
specifications: l
Owners Name
Address & Phone C91 &'S40 kt
Architect's Name k)1A
Address & Phone MIA i 1
Mechanics Name NIA
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Address & Phone I f�
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was a sw a tarlan�r `s``�DuPont �,i,:r,.i, •
and"of h+4dn04 M a dw+a g'for how mmy rama«T
WM bLAft cordon to law? Aebwtos? c
Ed"ed ooet.
Clly lJowre e N A e ,...
Hon Inprowment
Signature of Applicant i
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SIGNED UNDER THE ,
OF PERJURY f
DESCRIPTION OF WORK TO BE NE
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f
MNL PERMIT TO:
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APPLICATION FOR
PERMR TO
LOCATION
PERMIT GRANTED
AP AOVfl)
INSPECTOR OF BUILDINGS
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