17 CAMBRIDGE ST - BUILDING INSPECTION ImSf'OE fll.E�'ApfPROVED 13Y T44E
WBAEC16R .PfWR Tp`A.PEF3flAl7.SEWG GRANTED
CITY OF SALEM
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No.. ,'�•• �. �� Date 3
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Is Property Located in Location of
the Historic District? Yes�No_ Building (7 5—
Is Property Located In
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof Install Siding, Construct Deck, Shed, Pool,
e air 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 _Z ¢-70 xl_l, /,UAi—Zoc/<�f��
Address & Phone (9'0 ) 7/l 8o e3
Architect's Name S 14� J�
Address & Phone ( )
Mechanics Name �—
Address & Phone ( )
What Is the purpose of building?
Material of building? �7/� I�//� If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost 0 L7 City License# N " State License #
Home Improvement
Lie. i
jSigna of Applicant6 UNDER THE PENALTY
RJURY
DESCRIPTION OF WORK TO BE DONE
j /
MAIL PERMIT TO:
No. J �
APPLICATION FOR
PERMIT TO
LOCATIOt7
PERMIT GRANTED
APP OV�D
INSPECTOR BUILDINGS
' II