3 CLIFTON AVE - BUILDING PERMIT APP (003) APPLICATION FOR
' PFpMf TO "
LOCATION
/
_� C,�it-�ru Fl✓en/✓E
PEIM T GRANTED
A VfD
P CTOM OF 6U INGS
CERTIFICATE OF OCCUPANCY .
YES
NO �.
DATE:_ ,-5 �� 7
Citp of '45a ' 1, a55arbUE;Ptt2;
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED/--
Location of Building Cl/tT0/J �}y`2�)1J2 aglI l
Building Permit Application For:
'(Circle whichever applies) Roof, Reroof, Install Sidin"onstruct Deck, Shed,Pool
Addition, Alteration air/Rep ace, . undation 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:--j/ j N MJ M Ih aan Contractor: A e A SerVICe5��rt5 f7t
Street_,3 OA+ 1 City Ilem Street 11IJor4h 5 ". City- � lam
State. Mfl Phone ( ) State M A Phone- N7 9) 7y
Architect: City of Salem Lic# 05
Street City State Lic 057 HIP 4 O to 09
State Phone ( ) Homeowners Exempt Form_yes__,./no
Structure: (please circle) Single Family, Multi Famil a Other
Estimated Cost of job S -11 d-0D'D O
Will building confirm to law?_yes no
Asbestos?_yes ✓ no
Description of work to be done:
�r�Sfa�f five �5� Vint/ rip/a�err,cn>< r.Jina'ot�JS
A&A SERVICES, INC.
Drawings itt d: es no Mail Permit to: 1 SALEM,IMA 01970
X
Signature of pplicati ,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE