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�9fQSiehliSi�9E fK NDI HWMOVEV BY T+IE „r
IAIS�i?F.CTAfJ P1$J�IA D,y# PEF"T BEING GRANTED
CITY OF SALEM
No.q 1 —d�JV� 3`� .� �. Date L'
it
Is Property Located In Location of ff
the Historic District? Yes_No Building
Is Property Located In
the Conservation Area? Yea,_No)E--=
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof Reroof Install Siding, 'Construct Deck, Shed, Pool,
RepairlReplaUcef Other:
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:
Owner's Name
Address & Phone 9DW S�. '^^ t voA i
Architect's Name
Address & Phone Mechanics Name SCA S c/+a
fA
Address & Phoney ' rr�t �X S (`kS1 )
What is the purpose r f building? r[ es au �
Material of building? \AJC If a dwelling,for how many families?
Asbestos? i,;
1 „p Will building conform to law?
"G A
y Estimated cost OO •00 city License t N to LI
now Improvesent
Ig��l
Lie. ! / 9 P
SI nature A piicant
�.
SIGNED UNDER THE PENA ,f
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
r, P �eP-1r
MAIL PERMIT TO:
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alp
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sow sl •�
S troS 1^'1G� cJIGi8 V� I•
4'� `
No.
APPLICATION FOR
PERMIT TO
-- % LOCATION
PERMIT GRANTED
�/OU/a
APP�/ VfD
INSPECTOR OF BUILDINGS
3