7 BUFFUM ST - BPA-2006-372 1111�1AUST13E ffL*"M AfVROVE0 BY T44E
1WZCILIB PBIDR TVI A.PEI"T. MIR GRANTED
77 CITY OF_SALEM 1
Date
1j�ir m
Is Property Located In Location of
the Historic District? Yes_No
Is Property Located In
On Causmadgn Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, 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 Ail— 1 a /,,/C
Address & Phone -71u �.,�7 /
Architect's Name a41,54
Address & Phone N1 j 1
Mechanics Name ail
Address & Phone h11
what is the purpose of buildup?//
Momw of bta WQ? 4L,/Y Si 4 2V4c II a dweling,for how many IamWee?
WW building conform to law?�5 Asbestos? AidIL 2
Ealknated cost /J/np 'bro GN ucanse M N P' State License K
Haae improveaent
Lie. , X
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
No.
APPLICATION FOR
PERMIT TO
4
LocAno
PERMIT GRANTED
AP OV D
p
INSPECTOA OF BUILDINGS
x