0035 COLUMBUS AVENUE - BPA 06-996 ggA"q"v-BEfgf kVW APPROVED BY T44E
SAPISM PWR TO A P.BBNIr AEINti GRANTED
CITY OF_SALEM
No. 99 s o. ( ,k,-e,Is .
Loomed
HiHMo�iktaYldal?„
" Ysk—No� awa"Ing
Is Pmmfv Loomed h
aw Cmrrmsa"Aka? YsIL�No
BUILIM PERWT APPLICATION FOR:
ParmA t X
(Circle whi hWW apply) Roof Rmd Install Sid Dods. Shed, POOL
RspawRYplaca. ear: p oa ; v ps,
PEASE FILL OIJtT LHUBLY•COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUKMU4S:
The wWwag-ad fwsby applas for a permit to build aamrdinp to the folbwmg
owmea Nye ' a i^ r—w S f
Address A Rww 3�Co ju.�r S f 74 Z/
Amhkeds Name
Address a Phone
LAOGNU)ica Name CletjPO S ,
Address6Phone B �a �;� ' Vgs 0 ( � Yj281 �i27-�gsa
MwAdm a b? wo d w r a*wO%.for raw smay hakes?
wlr twrdrq oononn a hw7 �a �� _JNoaws?
Eausa ed am a,fib/ ow License• ►J A momman larrawspa"
Lloaw• bo2 i
Ur
poww'of Applicant
SXWD UNDER THE PENALTY
OF
DESCRIPTION OF WORK TO BE DONE PERJURY
rl�'�'G{�.+�//�QL 4/•
MAIL PERMITS��o l u fvr h�.P
No. .Z�-
APPLICATION FOR
PER1tf11TO ( /�
LOCATION
r
35 Co(k -, Az s
PERMIT GRANTED
INSPE4"f OF BUILDINGS
•