31 COLUMBUS AVE - BUILDING PERMIT APP DATE:
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building ,/I� 401611?�bus rrU�7IU�_
Building Permit Application For:
'(Circle whichever applies) Roof, Reroof, Instal ' ' g, o ct Dec , Shed Pool
Addition, Alteration, Repa lace, o on Only, Wrecking
Other:
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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: �(U/tG (�jlr �� S fiP,Y Contractor: C h r; s t n gh P r z n r e
Street q �I1_wPy S+ City`Re)JPAU Street 119 North StrPPtCity sal Pro
StatelVlPr Phone (t7 State MA Phone (97.8) 741-0424
Architect: City of Salem Lic# 1405
Street City State Lic#0 5 7 7 3 3 HIP# 101609
State Phone ( ) _ Homeowners Exempt Form es�no
Structure: (please circle Single Fam➢I • Multi Family# Other
Estimated Cost of job$_
Will building confirm to law? I�yes no
Asbestos?_yes "no
Description of work to be done:
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SERVICES
Drawing u mitted:_yes no Mail Permit to: 2-Y6 NORTH STREET
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Signa re of Applicatio ,SIGNED UNDER THE PENALTY OF PERJURY - -
CONSTRUCTION TO BE COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# -1�y- Zoning Map/Lot i
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Permit fee$
COMMENTS:
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