2A BUFFUM STREET EXT - BPA-2004-114 V
1fttST-BEf4Lff --ANG APPROVED BY T44E
.INS.PECTPR ,PFWfl T-0 A.PE1MT B•EWG GRANTED
CITY OF SALEM
No. H.`� "L \ Date i •3� '63
1
Is Property Located in Location of II
the Historic District? Yes_No_ Building Z A urn
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roo Install Siding, Construct Deck, Shed, Pool,
Repair/Replace ther:
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 W,Io�d Paror.�
Address & Phone 1. A go � Fr..�1� S�. (21B) '1q$ - 110
A ' is Name 5 cat t,rrn I I Q • Q lit lb
Addre
Mechanics Name RMA 4�0'y)2 Sr?culCes
o,,J\ 345 (5L-rre t rN-wo oc'
Address & Phone \A )nrceS 1-t-T- Mo. . OI ko (w ) gn -312$
What is the purpose of building? 2 e a;t�tt—
Material of building? If a dwelling, for how many families? l
Will building conform to law? Asbestos?
Estimated cost 2, 000 City License # N A State L cen a #
$2-0 Home Improvement
Lic. i I L6b 43
Ct; S 14 ,, Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
5vr�c, m� �hG�A tl
l� -Val„ () .23
r
MAIL PERMIT TO:
.1.
No.
y .
APPLICATION FOR
PERMIT TO
LOCATION
-PERMIT GRANTED ;
/03
APPROW�D.
!
INSPECTOR OF 0 DINGS