69 BRIDGE ST - BUILDING INSPECTION ' S 1
fiSIdOST-BE JE 'fli'�WPROVE-D BY T+IE
.IWSIPFXT68 ,PIWR . IA PT SEMG GRANTED
C CITY OF SALEM
.`'No ,N� � � Date � —Z - 0L
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Is Property Located In Location of
the Historic District? Yes_No_ Building
Is Property Located in
the conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof Install Siding, Construct Deck, Shed, Pool,
Repair Replace Other: IZ,:r o v . d. LA<.e U 4)(A a e<�s
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 13 r b 4 <.z.
Address & Phone `� e, o c--,� S-t- Lc?7 @'7 45 9 f. 9 IS
Architect's Name
Address & Phone L )
Mechanics Name
Address & Phone i i' M./511.il.Sr- 4 Lnc,r/ (`t)?)531 8Z3�1
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost Z �' — c tv Ucertse N N A state License 0 0 S g 4 R �
Boma Emprovexont // 1
/r�, Signature of Applicant °IE
SIGNED UNDER THE PENA��,OlrY �,I'�� ,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE '(iif
N,i!t
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,
MAIL PERMIT TO: �T �• J �! Cr l I q A c i iue ;
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0 )
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APP VfD
INSPECTOR OF BUILDINGS~
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