3 CLIFTON AVE - BUILDING PERMIT APP (005) DATE: J_ ai - o_7
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building
Building Permit;ApplicatU'lion.
(Circle whichever applies) roo Install Siding, Construct Deck, Shed, Pool
Alteration, Repair/Replace, 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: �, Contractor:
Street City Street City
State Phone ( ) State Phone _ZV -aU75
Architect: IV�A City of Salem Lick Z 32
Street City State Uc# 62zd HIP# /5//„?
State Phone ( ) Homeowners Exempt Form__yes no
Structure: (please circle) Single Famil • Multi Family#_Other
Estimated Cost of job S /
Will building confirm to law?,Lyes no
Asbestos?__yes .,.100
Description of work to be done:-
Drawings Submit d e no Mail Permit to:g�M
Si re of Apolica ' n'S1 N ND ER THE PENALTY OF PERJURY
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CONSTRUCTION TO BEtCOMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE
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Department use only: ,Perriull?# _ Zoning P lap/Lot
Permit fee _� �
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