46 BUTLER ST - BPA-2004-250 -ft ? M0 T.-BE ftL{-�,APPROVED 6Y T44E
LN5PZCTD.R .PFWR TD A.PERMIT.B9NG GRANTED
CITY OF SALEM
No. 2S0 -ZJ3O `t. ..� a�` \ Date
Is Property Located in Location of
the Historic District? Yes_No Building *L 1
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Pepair/Replace,
Reroof, Install Siding, Construct Deck, Shed, Pool,
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 DWA LgAealalJ
Address & Phone Bai e 6�-
Architect's Name
Address & Phone ( 1
Mechanics Name J AN�f�2 c Ey rbwyYg ats E
Address & Phone Aloa- kup Sr ma L 1 rj 3,3 Irk%
What is the purpose of building?
Material of building? If a dwelling,for how many families?
Will building conform to law? Asbestos? V,
Estimated cost � � City License # ►`I p' State Lic # &910
Home Improvement X
G ��kZ�l Lic. i Sig ture of A ant
SIGNED UNDER HE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
% d���F.�c��iMblPcr�'�Syf/N6G�� /�fls�,411 ICE s I�✓�tfik2 �Sll��
MAIL PERMIT TO: 'yl0 l c 4 ,Ing
.t.
No. 2-5
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APPROVED
INSPECTOR OF BUILDINGS