24 BUFFUM ST - BPA-2005-740 i10LA SiMWT13EfiLff;-iNO APPROVED BY T+IE
.jNSPZCTDB ,PFWfl TP A_PERMIT BEING GRANTED
CITY OF SALEM
No. .;3v '� � Date 3 : os
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: -;\3Ereeo,- eerw06® L / Zry�ne t��o�KS
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
a42ty
Address & Phone ?R3 e�Atjp-g AtigKeN � f 3) r3�c33 094 (a
Architect's Name
Address & Phone l
Mechanics Name A61,4
Address & Phone
What is the purpose of building? C-
Material of building? U000 D If a dwelling, for how many families?
Nil building conform to law? Asbestos? N D
Estimated cost //$ no o
—'Cfty License• N P' State License 8
� Boine Iaprovm ent
9 , 6 V Lic. ,
S16hature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE p
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MAIL PERMIT TO: ZA 91(P41h 54' ( 97 12
No.
APPLICATION FOR
PERMIT TO
LOCATION '`
vv
`i PERMIT P71TED
APP OVfD
POCTOR OF BIJADINGS
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