10 COLUMBUS AVE - BUILDING PERMIT APP (002) ,,a i...:..,/•',;-:
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fL'AIAQiMb6*'BEKim Ilia. OVED BY INE
JdSAECIL�COs DBEING GRANTED +'
CITY OF SALEM
No. -��� Dale O�
Is Ply Lopbd In Locatlam of
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M Pmpwly LowMd In
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BUILDING PERMIT APPLICATION FOR: '
Permit to:
(Circle whichever appy) Roof. Remof, Install Siding, Cor� Shed, Pool,
RepalNRepim. Other.
PLEASE RLL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROMOM
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the foUw*tq
spec ficatlons:
Owner's Name 114, if wyll-G/ 4/1"� 1 y
Address & Phone 7V SSS 6
Amhkeds Name .L/®*�~/5t—
Address 3 Phone f
Mechanics Name
Address & Phone
wntl k ft ptapae w ww
MttMtttd a b~ �/�00� r a dwdlYtO,for how many WAM?
WE tM av contort b law?
EMlmmlmd cog.�cpy Lloaw• N A
6,6. Ott
Ue. t i
U ature of Applicant
SIGNF�D UNDER THE '
OF PERJURY
DESCRIPTION OF WORK TO BE DONE C
a& Zak
A ply.,
MAIL PERMIT Ta
BMW
NO. �[l �
APPLICATION R
// PERMIT TO
' t
LOCATION
PERMIT GRANTED
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AP AOID
INSPECTOR OF BUILDINGS
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