26 BUTLER ST - BPA-2004-406 I x~'
+t*NSW STYE f Lf -MG!APPROVE0 BY T44E
" TCW ,PF JOR TD .PERMIT.B,EW G GRANTED
CITY OF SALEM
CON
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No. �.,, �(o'ZCJO�Q �e`` �� '�'; Date Zo - Z/ —a 3
5,.ry
Ward
Zoning District
Is Property Located in Location o S�
the Historic District? Yes_No_ Buil �ding Tj-L= Z
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) eroof, Install Siding, Construct Deck, Shed, Pool,
pair/ eplace 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 lc vt `k e( �Q �� /�� L14
Address & Phone /, �u r s
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone Yj
f j ) ZS Z-
What Is the purpose of building?
Material of building? if a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost City License 8 State Li sei
Home Improvement
Lic. If /�D �
49,66 Sign ure of Applicant
SIGNED UNDER THE PENALTY
�O ln-Z ,o OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Q
MAIL PERMIT TO: 4
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