1 1/2 CAMBRIDGE ST - BPA-2006-373 -PL-*M11AUStIBEfILE� APPROVED BY T44E
jwS =IW PPJOR Tp.A.PEF3W,T BEING GRANTED
CITY OF SALEM
Date /D
s
Is Property Located in Location of
tyre Historic District? Yes X No_ Aaildiag Z r a i• /3r ;Z S�
is Property Located In
Me Conserved m Area? Yak No.
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: PATH aa22K>6-!,
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 krA (L�Eay�1-%g-
Address
-rAddress & Phone
Architect's Name
Address & Phone 1 )
Mechanics Name`— N e-1
y 6 Si4i=pRtLL s
Address & Phone 5 iN- ems, o,¢?a (96-1-) 639 OG 7
Whet is the purpose of building? Qo c� ce
Malarial of bWlditg? h a dmW tg, for how many laminas? /
WW biking conform to taw? Asbestos?
Eonated cost CRy Ucwm r W/o' Stake Uoartse r
aar Lprovenent
�3 �� Lie. 3 X
Signature of Apoicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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ANS CJS (_�� ^)Z) E.KTe ri �2
MAILPERMITTO:�r��eoP� j
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No.
APPLICATION FOR
PERMIT TO /
ane cJe / ���j
x
LOCATION
PERMIT GRANTED
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APP OVfD -
ECTOR OF BkOLDINGS
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