12 CARLTON ST - BUILDING PERMIT APP �L4�4QSd9HiS EfiL-E - AP42ROVED BY T44E
LN5.PI: TD-B ,PWRZp.A.PERMIT.BEWGGRANTED
CITY OF SALEM
No. Ci 3-ZOOL� y�`' ,� �` � Date
n yi` k'.
NB
Is Property Located in Location of �
the Historic District? Yes_No Building
/2 af- p
Is Property Located in
the Conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidin4=ConstructDec 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 �ma /STi�(5���
Address & Phone /rx Ca /Ten 5-1-
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone
What is the purpose of building? r;2 /a' inr/� 12le
Material of building? V"OC)d If a dwelling,for how many families? 02
Will building conform to law? 6. Asbestos?. yn
Estimated cost o city License # N A State Licen # 96—
e
3 pQ o 00` Home Improvement
Tx Lic. i
Vv G tL 2�l Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
fi �conS�ry�� 6x S� nS �Q G.0 o� �.���/o � 7X/fir
! 1
MAIL PERMIT TO: /off C4r/7o1) 0/970
Sc'
t
No. I a 3 - 2-0c)y
APPLICATION FOR v o
PERMIT TO
LOCATION.
PERMIT GRANTED
APP VfD
INSPEC-TOR46F BUILDINGS