8 CLARK ST - BUILDING PERMIT APP 1%*N1B1AWT11EfNA04A D APPROVED BY THE
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CITY OF SALEM
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Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Rsroof, Install Siding, Construct ec ? Stied, Por t.
Repair/Replace, Other.
PLEASE FILL OUT LEMLY i COMPLETELY TO AVOID DELAYS IN PRO"88WO
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to,build u %-wj to the following
speciHcadons: ;-
Owners Name i eJ mac) to
Address 6 Phone Ss C(-4 ti
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Archkeers Name
Address d Phone ( 1
Mechanics Name M a-!no(d
Address 6 Phone ( l
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Signature of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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