12 CRESCENT DR - BUILDING PERMIT APP 14AMMWOE fiL494AD APPROVED BY T*E
WPZ=R P"M TO A IPERMfY BEING GRANTED
No ` CITY OF SALEM
J D#A
` ward
1s Ply Located in Lomtloa of
ON Helodo District? Yft No_ aeildioa %Z
18 PIGMIV Lor.Ue 'in
the CCnenvason Ana? YeM
Permit to: No
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof,—R Install Siding, Construct Det:k, Shed, POW
.
�1spair/Replace Other.
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accord4iq to the following
specifications:
Owners Name
Address d Phone Odr- �RV( 7PI 14 V
Architect's Name
Address d Phone
Mechanics Name
Address & Phone
YNW M to p apoea cr E,rl WW
MMMW d tmldirg? M a dwalNq,for how wM hnrau?
wM- N - calm..to 1W AM@~
FelnaUd oast qly Uoerre•
ass. m
Signature of Applicant
SKiNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Aar W �
1
6 r Ci
MAIL PERMIT TO: /&QG dQf-
APPLICATION FOR
PERM TO
LOCATION
PERMIT GRANTED
APPROVFD
l• d?
1 OR OF BUILDINGS