40 BUFFUM ST - BPA-2006-878 -pL-A"S*lWT-9Ef4Lf9-MG APPROVED BY T44E
jm5Pf=DA pWOR Tp A.pEAMIT BEING GRANTED
CITY OF SALEM
Date
is y Located in Yak
of �L
the Historic District? Yaa_No w..i�ai„v J'
is Pmpwty Located in
the Cormmadon Area? Yes No,_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Poot,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY 6 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: Q
Owner's Name V�R�^�5 Ica bjy N )
Address & Phone y� �u ROW- 64h f 1 a')
Architect's Name
Address & Phone ( )
Mechanics Name t�,'oefa�v�tsec�
Address & Phone 2 &4--) Lyan ( Z0311
what Is aw prapow of bwairq? '"Zln
Material of bukKM? W pd n a dwelling,for how many tamwes?
ww building cordorm to law? Vt'S Asbestos? A-0
Estlmeted cost (O4O_� �y u� state license k
some lop
� e� Lie. f I, Si a; APPlicant
SIMED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: �`b
.t.
No.
APPLICATION FOR
PERMR TO
m.QCs¢ wS��,�ieS
LOCATION
PERMIT GRANTED
27 2.049
APPR V�D
S TOR OF BUtLDINGS