37 CIRCLE HILL RD - BUILDING PERMIT APP QPUMlAtISTIDEfNA0#ND APPROVED 8Y TW
JWPZCZOR PWR TD A PERMIT BEING GRANTED
2\ \\\ CITY OF_SALEM �t
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Permit to: ING � �� I IZ�1.>_ I'T
BUILD PERMIT APPLICATION FOR:
(Circle whichever apply) Reroof, Instal Siding, Construct Deck. Shad. Pool,
ZaRepiace, Other
PLEASE FILL OUT LEMLY&COMPLETELY TO AVOID DELAYS IN PROCESSNG
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build aocorckig.to the following
specifications:
Owner's Name />uT / tS�Zo�G
Address Q Phone �� l ,12CLIE t k LL R-b 04 ) -7 45 -
Architect's Name
Address A Phone [ I
Mechanics Name `N C H Ho�4
Address & Phone CdeS 2ks Qn 1q/S1 5-1oq - 57(0G
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MOON of btM WA2EUALT Sf•+&GLO a 11 - 0q,far how mtmy Wndn?
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EtennNd and -7, 000 pty uc • etas ub •
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Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE G�iTZIP PrROOF 0 SO
MAIL PERMIT T0: I BIT"11 c1*10TTY
HOME DEPOT I
4 COBURN RD.
L�T`,'NGSBORO,MA. 01879
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