40 BUFFUM ST - BPA-2005-719 I
-PLAMM T-SEfILfG-;MND APPROVED BY T44E
.INSP,;£,GTLB pRWR TD A PERW BEING GRANTED
CITY OF SALEM
No \\ y`' Date
s�tp
it
Is Property Located in Location of
the Historic District? Yes_No v &sildinB 1/D a°wo Sr
Is Properly 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: mvi goof
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 Namet`b5
Address & Phone 610 go V-�j vv-� Slve* f; 5781 Wq T9 72
Architect's Name � —
Address & Phone / 1 1
Mechanics Name _ &�lo-r\ C-�n x ueulnOcx--')
Address & Phone
Whet is the purpose of building?
Material of bullring? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost 4U00,G"J City Ucense Q N P' state License tt OS'Ly S 3
Maine Iaprovenent
Lic. i X �L
Si Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Qe l AkWo�— re3 S
MAIL PERMIT TO:
orCie
No. — V�
APPLICATION.FOR
PERMIT TO
I
LOCATI "'
PE MIT ANTED
2.0
APPROV�b
ECTOR 04 BUILDINGS
1
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