5 CLEVELAND RD - BUILDING PERMIT APP x
Pi Iveo$Y ZiIE
AWNG GRANTED
CITY OF SA�EM
No.
1' r
�.d
1<amt�OR of
�°Loomm ti r.�No� a.ivasas s e�el_�
Is�r Lowbd ti
b Cawrmlon AmW He
BU LDNO PERMIT APPLICATION FOR:
Pwmk to
Ode whM wer apply) Roof. Remof, IndW SWft nWm. Shad, Pool,
RpaWR"Im. 00w. .
PLEASE FILL OUR LEOIKY a COMPLETELY TO AVOW DELAYS N PROl
TO THE INSPECTOR OF BIJILDINGL-
The undaMOW hereby app0m. for a permk to WW axordlnp to M» tokawMlp
. epealAoatk�
Owrara Name �aaNe.r �rPe�
Ad*m a Phom a^ CledP 4 Y g d•
Ant#A s Name
Addma a Phona ( 1
Mod anlca Name
i d
Addmaa a Phone c rus
1
Whd w No p.pm if eualrgr
IAIIMW d�Ot 11 a swig,for law sry hmNM4
' MIS oonblln b hr►9
Ovrdiq ,r
ooM. o�o�=ghwl • N A a1MDUMM• Cis
Lie. I P• . aS ,.
of n
SIGNF,D THE I
OF P . RY
DESCRIPTION OF WORK TO BE DONE
pea.
w 6` MAIL PERMIT T r
h
� u
k�
pHE'
• r
9
R
^I nm
}
r
e
• p M
12 N .
.� _t-!-_f._ � I � � I t- _ r_ -1'� � - '. i � f r 1 �� �( i � i 1 �• - 1 I i � ' � '. ! ; � r
y I
I '
I
-
I
Al
I
I I ,I
i
I I I I I I
>pow
6'C-
IC
+ i rt ' i �I d`✓S 16 R'vClJ�eu�y - 'I/V O•T ':
;4N
,ba(66t�s+
Q_It 4x4t Ralf to be Te'fon i
' TBes 4' be(cw
I
1