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DATE:—
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ATE:CItp Df a�A�EIYi, a��aL�USEtt
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building �C e j-� r cS�
Building Permit Application For:
'(Circle whichever applies) Roof,Reroof, Install Siding,Construct Deck, Shed, Pool
Addition, Alteration, Repair/Replace, Foundation Only, Wrecking
Other.
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AV.OED DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies for a permit to build according to the following specifications:
Owners Name:2 8,� e.l a i Contractor,
Street C't?� r �� City��}/e✓�) Street City
State Phone (978) 7f1���'�� State Phone( )
Architect: City of Salem Lic#,•
Street City State Lic# HIP#
State Phone ( ) Homeowners Exempt Form_yes no
Structure: (please circle) Ingle Family, Multi Family# Other
Estimated Cost of job S o'SDO
Will building confirm to law?—YM no
Asbestos?
_yea no ! !
Description of work to be done:
D gs S ed: es no Mail Permit to:
Signature of Application,$ GNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO M,OOMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
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Department use only: Permt('#)')�M Zoning Map/Lot
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Permit fee$
COMMMS:
MORTGAGE INSPECTIONPLAN
NORTHERN ASSOCIATES, INC.
401 SOUTH BROADWAY, LAWRENCE MA.01843-3522 TEL-(978) 837-3335 FAX.
(978) 837-3336
MORTGACpM- LEO S.$. ANIGE M.DIJPUI5 DEED RER
LOC-ATM 1 GENTM 5T PLAN REF 5/II
CITY,STATE: SALEM. MA SCALE: T_20
DATE: 7/14/00 JOB#: .100/03971
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