22 BRIGGS ST - BPA-264-2006 _pig4 JAIllST�K fiLf� AfkPROVEO BY aaiE
IWZ=DB PFDDR TD A_PEAIfAIT f3,EWG GRANTED
CITY OF_SALEM
No7) 3_�% +� \' Date a
Is Property Located in Location of
tics Historic District? Yak No✓ Building ,` PSS'
Is Properly Located in /
the Conservation Area? Yes No�C
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof Reroof, Install Siding, Construct Deck, Shed, Pool,
aidReplace, 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 Fs ov D G.t G
Address & Phone a
' Architect's Name
Address & Phone If
Mechanics Name IVA rj oo .11
Address & Phone wa o f 9A ' 's Ezz
What Is the purpose a building? /
Metedel of bulding? n a dweWN,for how many famYles? ,Tug
WN t uMN cordorm to law? Asbestos?
EsSnated coat 9 90 D_ CIN license 0 N 06 &RIG License«_iZ/
Rarae Improves sent
Signature ooffAApplicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION-OF WORK TO BE DONE /
f 7L, --9/7 eyl— �iJ
MAIL PERMIT T0: O Zal- /2r,
No.�
APPLICATION FOR
PERMIT TO
5 fry �
LOCATION
s
PERMIT GRANTED
2.b
APP 0,40
INSPECTOR BUILDINGS