14 CHURCHILL ST - BUILDING PERMIT APP fLINIGlMl6i`�EfNa ID APPROVED BY THE
JdS1'J TLiB P91QR MA.PEAWT f3EW91 GRANTED
CITY OF_SALEM
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BWLDWG PERMIT APPLICATION FOR:
Pormt to:
(Circle whitlwtwr apply) Roof. Remd Install S Cortctruct Dark, Shed, Pool,
Rom •
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS.
The wwWso-ad hereby applies for a permit to build according to the following
suscificatiorm.
Owners None Co' Ah 6;iA°22
Address A Phone I)g CA4A-6 j✓i vA^ L4M A . e2l-17 y/—5 �
Architect's Name
Address & Phone i 1
Mechanics Name2/a
Address a Phor*2,L 0 L `/— �hv�G�AA (A;V-19 . L--ZZ�y
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Eat"m oort/���City Lu..• N A state u."r o
tee. Sigrwtu of Applicant
SKMED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: . �''h°CM,
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