14 CHURCHILL ST - BUILDING PERMIT APP (002) r�
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CITY OF SALEM
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Is Property Located in Location of the Historic District? Yes_No Building (/`/
Is.Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof Reroof, Install Siding, Construct Deck, Shed, Pool,
Roof
pair/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 /�2 ✓,-�3 G�A�i 1
Address & Phone 79/"vW17
Architect's Name
Address & Phone 1 1
Mechanics Name✓-0 4Aoz &a,/M Co?2-AeLn-� LLC 4
Address & Phone � / /L�1n LJ1 (IEV�,po/y,(T197� 1 yLZ—ZZy�`
What is the purpose of building? 61-1 db4
Material of building? 4A(i ,o If a dwelling, for how,many families? 012
Will building conform to law? Y�y Asbestos? /Y4
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EsUmated cost ✓-City Ucense ae N A state License # �ocL
�!p Rome Improvement
n i�a� Signatu Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: fir/ ClIf c7el,LL 22AL" o�f�
No.
APPLICATION FOR
PERMIT TO
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LOCATION
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PERMIT^GRANTED
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APR VFD
INSPECTO OF BUILDINGS
?Y .