51 BUFFUM ST - BPA-2004-951 i�L'dtM61Mb8f`BE SY INE A#ROVED
aFJNR GRANTED '
CITY OF SPLEM
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Is Ampetty Located in Location of
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Is PlaPMty Loaded In
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BUILDING PERMIT APPUCATION FOR:
Perna to: I
.
(Circle whichever apply) Root, Retool, Install Siding, Construct D"K Shad,f Paol. ] .
RepalNReplace, Other. . ��
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROCENO
TO THE INSPECTOR OF BUILDINGS: ~
The undersigned hereby applies for a permit to build according to the folbwing
specifications:
Owner's Name
Address A Phone r! I Y Y S y
Architect's Name
Address & Phone ( 1
Mechanics Name
Address A Phone
t i:n
What Is Vs purpose d WMW
hU"ol car ttulldktp4 N s dwNYp,for how many hmlMs7
wN(uk"mtomt to WW
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aar Iapro�at v � A.
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�� Signmure of Appllcen't
SIGN40 UNDER THE
OF PERJURY '
DESCRIPTION OF WORK TO BE DONE
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y
:fib a
MAIL PERMIT TO,•
No.� \
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
AP P OV
W—Lt .v�-
INSPECTOR OF BUILDINGS
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