6 CLARK ST - BUILDING PERMIT APP (002) fLw1eS1NISt�Efftr6i�WD APPROVED 8Y TiiE
PWR TDA agave GRANTED
CITY OF_SALEM
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BUILDWM t�Gll�� / PPLICA111ON FOW
Permit to:
(Ckcb whWi%vw apph) ��^� CwaM Ds shod Pool.
PLEASE RLL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCEBSWG
TO THE INSPECTOR OF BUILDINGS:
The wlderegred hereby applies for a permit to build aocwft to the fouorwrp
Owrers Name FI`LSE
Address a Phone CL 9 S a?R"1
AmhkoWs Naew
Address a Phase j 1
Modmics Name -.E] , i i`IU 0
Address & Phone 3
V*w Is No papon a bWldtip?
L W W a b111dU1p9 1 a*&*Wrp,for how many km6n4
wW b A tq cmlwm to law? AWNW?
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line
Lie. i q x�- � of Applicant
BMW tI1 =THE PENALTY
OR PNLRW
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT
NO.
APPLICATION FOR
PEWI T
LOCATION
PERMIT GRANTED
APPROVED
UGPECWR OF LDW-M-