4 CLARK AVE - BUILDING PERMIT APP 14
JNSAECIL3A �4ND ' OVED BY T44E Y r'
DING GRANTED
1 \11 CITY OF SALEM
NO.\, ��'v "� i Da
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Is Property Loafed In Location of /1 �1
theto Hido Didild? Yak_No� 1lni]ding C"k ne H ve-
Ie Property Loaded In
on coruerwAign Arm? Yee,_Noy,
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed Pool,
Repalr/Replace, Other: O tf o) n ha u t Q rn I A n
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCN'IN10
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the folkrwing
specifications:
Owners Name n n P C. 1�I k n-r`
Address & Phone �° 1 a r 1< v c 0.190 rl 4 a 12 ,4
Archkect's Name
Address & Phone
Mechanics Name 0 rn c o
Address & Phone
What Is#w
purpose of tarNdinp?
A
mats"a buYdrq? n a dwelWrp,for how merry f rna.e4how
.,.tx
WN buildup conform to kw? Aetrerrtoe7 ' I
Ewnruad wet. : _csy ucenw e N A state Wanes e
X
now Ieprowaent
Lie. !
ignature of Applicant
OF PERJURY UNDERSIGND THE PEWI' N II
DESCRIPTION OF WORK TO BE DONE
kf N -------------
Ni
°:j. MAIL PERMIT TO•
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
26 '
AP OV�D
INSPECTOR OF BUILDINGS
3
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