16 CIRCLE HILL RD - BUILDING PERMIT APP i
f
NO.
APPLICATION FOR
PERlW TO
paar
LOCATION
PERMIT GRANTED
19
VFD
INSPECTOR OF BUILDINGS
fLwNB*W13EfNA04AD APPROVED BY T*E
MPZCMFJ PWR TO A PERMIT=1NO GRANTED
CITY OF SALEM
No. l ' Dde
Ward
zm*V ofa m
Is P10POY Loeatad in Loeatioa of
NN 4abprlc MOW YM No
Is ProP"Locals I in
ara Cor"rvaNan Ana? Yo No
Permit to:
BUILD.M PERMIT APPLICATION FOR:
(Circle whichever apply) Roof. Remof, Instal Siding, Construct Deck, Shed, Pool,
Ir eplace. Other.
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSM
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accor&q.to the.folbwing
specifications:
Owners Name �IA V IOAvA Fo2e4, 1
Address 3 Phone l( C('rc l e 14 .. l 12 d , 3 0
SIR lee..,
Architect's Name
Address 6 Phone ( 1
Mechanics Name Co„le C o j C.
Address A Phone ao L o r �c-,- s A- �., , (9271 7 7 7- ?
vyA
What Is to p"oaa al WOW
AA11MW d buMdrrp? hJ o c d N a dwalMq,for tow mmy fanraaa? 1
WN bLfir0="44r to law? �( r s AabaatDs? '�j 0
EftlnMhd coat l�L,4/0 0 m umm a lcan •
Laws ImvrO.awmeLie. I
;
Signature of Applicant
SK*= UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
� cnl,ace6 ex ('5 SIi'di'ng 'PA t.'t) Poo, . 141, A/e LjPi+LroDaa2S
Owl ! UU'/ o r l-
MAIL PERMIT