12 CRESCENT DR - BUILDING PERMIT APP (003) l'km
JdSAFCIL 'PPROVE0 BY TiIE rBs a
D . .F WING GRANTED
�\\J CITY OF S LEM
No. Date
' w
s
Is Rop"LoosW in Location of
Vie Historic Dlstdd? Yes_No i/ Building ;
is Property Located to V
;a to Consovi Area? Yea_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Reroof, Install Siding, Construct.a 1 Shed, Pool,
A ppa'WReptace. Other.
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROODSWO
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name r fi o N J✓A M v a /- c Al
Address & Phone )�L C RZY6 ��n✓7 I)ir A c?m ivy 4a-Or .
Architect's Name A/ /A
Address & Phone A111) ( 1
Mechanics Name &j( c D e y
Address & Phone 5�/ M4 (Ifl 4-4,;713,f3 �(
.�
Whd I.to purpose al buYdW /i�G�Se DcA,t,a L
Mai of buYdrq? AYad d M a dwel4rp,for how many hmiles?
wo mov wnlorm to law? 1105 Asbestos?
EsU rated cost. _�2ao 0 Cty license r fU A atme Um"M �'S 01
v� some Imtoe t
`\ C Lie. / lCr 3G94
Signature of Applicant ;
SIGNED UNDER THE
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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1 n fA
MAIL PERMIT TO: Z! , " if/ GSwre it S%• +-%Wn- ✓�
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No.
APPLICATION FOR
PERMIT TO
Roo �c
LOCATION
PERMIT GRANTED
--ram
AP OVFD
INSPECTOR OF BUILDINGS
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