12 CLIFF ST - BUILDING PERMIT APP DATE: q• 'J-O(p
t
�1-1-el-11-7
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building /oZ C�l >CF 51re e-4
Building Permit Application For:
'(Circle whichever applies) Roof, Reroof, Install Si ' ct Deck, Shed,Pool
Addition Alteratio Repair/Replace oundation Only, Wrecking.
Other.
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings: a��
The undersigned hereby applies for a permit to build according to the following specifications:
Owners Name: /-tYYQlne. 5pu5Q Contractor: Cnr; grnnhar Znr7.
Street la 011IW 5�12P_ CitN 521en Street 15 North Straat C(ty�alPm
State -l. Y-. Phone (975)_7HH - 97o I State MA Phone(47g) 741-0424
Architect: City of Salem Lic# 1405
Street City State Lic#057733 HIP# 101609
State Phone ( ) Homeowners Exempt Form_yes 1L no
Structure: (please circle) Single Family, Multi Family# Other
Estimated Cost of job $ o?. 33 7, to
Will building confirm to law? ✓ ves no
Asbestos?_yes_/_no
Description of work to be done:
�h.SfYaII V/ /S) VIn L/ 0rg43X 4- 1J i.rndn )s _
Drawing itte :_�es� no Mail Permit to: 1.15 NORTH STREET
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x
Signature of Applic on,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# Zoning Map/Lot
Permit fee S
col* NTS:
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'i No. �j7-07
1
i APPLICATION FOR
PEAW 70
LOCATION
PE MIT GRANTED
-a 19
APP V�p _
G�
INSPECTO OF BUILDINGS -
CERTIFICATE OF OCCUPANCY .
YES
NO '