25 BUTLER ST - BPA-11-784 -`
�E7HST�E f#L+8,-kN0 APPROVED 8Y THE
WPFXjDR .P19 DR TO A PERMIT BFJNG GRANTED
CITY OF SALEM
u
No. t =2.00�\ .t`� "L �`'p� Date
Is Property Located In Location of /�
the Historic District? Yes_No_ Building 2 [JV7Lt�]Z 5 .
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:
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 J 4,4 /!/ Y �2 iQyf i.P 4
Address & Phone tZ�2 I I
Architect's Name
Address & Phone ( 1
Mechanics Name
Address & Phone ( 1
What is the purpose of building?
Material of building? If a dwelling, for how many families? _
Will building conform to law? Asbestos?
Estimated cos City-L-icenae # N P State License #
Home Improvem ut
zp c lL z g c�Lic. t %/-Hrignature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
��rn 4) DF OVE211(kr�E:1 .�f-"vGIL OF H0M �
(�-Cor-
MAIL PERMIT TO:
No. 6 2- ^Zp oc-�
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APP.FD
INSPECTO OF ILDINGS
e: