1 CAROL WAY - BPA-05-170 CLUBHOUSE ADDITION 143%M1MUST19Ef EG-A dD APPROVED BY 744E
-INSPECTOR PWR Tp A.PE MIT BEING GRANTED
CITY OF SALEM
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No. Date .0 . O
ward
�.� Zoning District
Is Property Located in ✓ Location of
the Historic District? Yes No_ anilding V I N N I N UAfz4z-;
Is Property Located In / GLJUPjOVS
the Coruerw»ion Area? Yes_No_✓ ��i`tY
BUILDING PERMIT APPLICATION FOR: ` ��f u1 ��
Permit to: 1
(Circle whichever apply) Roof, Reroof, In Siding, Construct Deck, Shed, Pool,
Repair/Replace th _AtXDjZ(()NN(7
Im PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS-IN.PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build accord;ng.to the following
specifications:
Owners Name AnALTONO -5R4l7
Address & Phone I,% UNGOLN 5rp�taN,MAo2111 (a)7) IM • 1174 0
Architect's Name f'!21 >gr4t-0H)TC-GTV
03108
Address & Phone PLI, pix 94".MTHo5lf,t�NH ((add► (o L.�j, 8811
Mechanics Name NIA
Address & Phone
What Is the purpose cf building? i�� tl0 N MAGI t,l-ry
Material of building? wor,>Mbuf,fSblNlaI a dwelling,for how many fam8ies7
Nil building onn to law?T Asbestos?—No
Estimated cost 1✓ , city Licenser State ucense 0
Rase lWrovemnt
Lic. i
naltfire of Applicant
IGINVED UNDER THE PENALTY`
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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5TANDATIV I -r--/1V5heS N LbD"16
MAIL PERMIT TO:
NtC,HANI 6A L- (tit ftp-AT�11n U 'lam IS � Z�tJI-gyp
No.
J
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
f 19
APP OV�D
INsPFCT0l 4FUILDIN S