1-3 COLLINS ST - BUILDING PERMIT APP fl>tN611A116T�E fl I"M APPROVED BY T4*
MPZ=B PWR TD A PERMIT BEING GRANTED
CITY OF_SALEM
N '
Dafa
Ward
a Zamwg District
tha F WAft Diddd?InYas No motion of
in6
Is Piopmy LoaMd In
Iha Consanratlon Ama? YN No oC
Permit to: BUILDING PERMIT APPLICATION FOR;
(Circle whichever apply) Roof, Reroof, install Siding, Construct Deck, hed Pool,
Repair/Replace, 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 accordcig,to the following
specifications:
Owner's Name �v '�OcmL cto8 rvc.
Address & Phone i- 3 Olrl
Architect's Name
Address & Phone If
Mechanics Name /qzl�e"cic
Address & Phone /- 3 �f- ccka os S f ?4 7 5'5'-'FS-/K _
What Is to piapoaa of b n*W ,Ski ece
Memel of dlldttp? 4.vo<,C B a dwe*q,for how mmny famiba? /
WIN bMYkll v conform to law? S After
Edmatad cost .Soc•cam My Llama• ftft Lka ft N
mm rspzo cant _
Lie. I
S' re of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�c6-i cc- !O X Fr 54.�et
MAIL PERMIT TO: w� 5 � cz�� �",�c•
No. V-A
APPLICATION FOR
PERINT TO
LOCATION
PERMIT/GRANTED
19
APPROVED
INSPECT OF BUILDINGS
i