3 CLIFTON AVE - BUILDING PERMIT APP (002) DATE:_ /b - (7-0(o
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building_ Con Av
enue.
Permit Application For:
{Circle whichever applies) Roof, Reroof, Install Sidin nstruct Deck, Shed, Pool
Addition, Alteratio epair/Replac Foundation Only, Wrecking ,
Other: }
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies for a permit to build according to the following specifications:
Owners Name `RiobeA M tJ� I Qn r) Contractor: A g, /k .SP►1/1 CR$� - _
Street Pw-n rP City 'Solern Street 0.5 t\)o(4+.) .ail-. City_ ..SCtleiv-)
State. HA � Phone (qlg) Jo 1I -,1(a 1f) State MR Phone-016) 741--Pkf AJ4
Architect: City of Salem Lic# I u 05
Street City State Lic 059 HIp t, ((a Qq
State Phone ( ) Homeowners Exempt Form_yes__V/no
Structure: (please circle) Single Family, Multi Famil _Other
Estimated Cost of job S 0� a k4 44, 00
Will building confirm to law? / yes no
Asbestos?__yes t/ no
Description of work to be done:
Zrnslall hre� ( 31 �iln�( �v lnr�mvn7L
A&A SERVICES, INC.
Drawin b itted:_des no Mail Permit to: SALEM,MA 01970
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Signature of ApPliefition, SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE
Department use only: Pen-nit# Zoning lvfap/Lot
Permit fee S -
COZftMS:
APPLICATION FOR
' PPRIM TO
LOCATION
PE MIT GRANTED
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APPR p
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INSPECTOR 0 BUILDINGS -
CERTIFICATE OF OCCUPANCY "
,
YES
NO ., +