18 CROMBIE ST - BUILDING INSPECTION 4phom r moll!flthLY N AVVROVE4)4!Y 744E
JMPFC=PWR TO XPWW ABINO GRANTED
CITY OF_SALEM
N70 'jj\'A Ode
wMa
Zw"oama
k Pfowiv toeawd in twat"a.of
Ca9►hiorlc D OW Yet
Is Propwly lom m in
eN Cm -1 R ion ANO YM No
BtNLBNO PERMIT APPLICATION POW
Permit to:
(Clrols whichever apply Roof. Remof, IneW Skfhp, Cangnxx Do*. Shad, Pool,
astir:
PLEASE FILL Otrr LEONLY&COMPLETELY TO AVOW DELAYS N PROCEdpq
TO THE INSPECTOR OF BUILDINGS: '
The urtdersiprted hereby applies for a paenk to build aco"ip.to the.bNowj
Owners Name /4a 4(7a4 c .
Address a PtKx 1/9 /'//./ ,y41-eA "Ice4 - / a2 ✓ o
.90
Ankhkect's Name Z) K G o FF
/0. 19 4j-I
Address A Phone /ter- � e-91 9 71
Mechanics Name C L"dc. +�ko,ni l/
Address A Phone � ppk(4 &rPto
wht is ft prphaa it e~ ,a ti yle
IAo1Mla1 orb~ o o o qp, N a Grp,ror how mmy In nAn?
wr Odldlq oofronn to taw? ebfa7
Emomm wd 2 00,_lv� cov Uo • ummes r
seas rwmv t
Of A~
SIaiD �THE PENALTY'
Of PORNNIY
DESCRIPTION OF WORK TO BE DOME
kA.Du5c r Cs 4DU cq -6 VIA,
MAIL PERMIT TO-
1
/Y
• t
SONK1bio d0 /^OL 1I
yJ{
t y
a
031NVtRJ LWH3d
7 TO 4�
•�V=
' r
. . e e7VV r/ —Y09
CLL JAUM
MQJ NI011vJl7 w
1
. � y •
CITY OF SALEM
BUII INGDEPARTMM
HOMEOWNER LICENSE F XEwyno i
mum Fda
Di 9 /S o
JOB1.00ATION / Gro1+Yt6 e S .
HOMEOWNER
IHOMECo nm ono- 7rr-1 9 s-s-o?.7 y
Tames
=StRr MAELM ADDRESS
The cwrcat.ommption d'Iwmwwwe was, w b hAt, F-qpmpw,dwcwsv4Two
UWw a kas and to atiow sacb Umeowma to VWP an baS AU0.*c bim vrho does Sot pwsea t
1kcsm,paoviiw t alm owner ses as"Favisam
DErV4TIONOFHOMEOWN=
person(s)wbo owns s partal of had oa whkh behbc mides or b*asds a Tcd6l6 at whkh these k,Of k
amended w be,a one a two bx+fl7 dwcMn&stndred of dwdwd Mwtxw*=+ my to aeb is ss 'I
firm sovcmmL A pea=wbo wow=mm than one home in a tvroyess POW sbaC Satbe cmwUc ad
a bauwowoa. St4 lwmeow mf shaflsubn*to the BuDft O ��"
Bw'Idbrf Oifrc 4 that bchhe be aspmmbk t uch o aA s week pafa=md tAn*A boll
The wA=iyzd-bomoowaei"Lw mrs tespotmbitiq foe cmuFrA=Wkhlht State BoOMbl Coded '
otha appSabk foes br-kws,mks ad te=uLfiwt
Tbc wrdasigmd'iwawo TAe ocrtifia that hehhc wwiasisads the aw of Sakrn Baib ft
mmimwa i dpwu=pmeedwes UA mgmr�ns sad ftt hhhc w•BI cam q with aid prooaoes d
ra9oir®art
HOMEOWNER'S SIGNATURE- --
APPROVAL OrB=INGDWECTOR
Sec other side for stsa code
I
HOMEOWNER'S EXEMYnON
The cods states tbst 'aq bcumwaa Ierfarmbt wmk for wbicb a buDft pamil Is ttsgdned sbsl M
cXCMp Sera►she Pm4sioas of*h secdm (Secttou 3q.12-lfccnstmg d Cosrarocttoa Eupervbers;
provided that is•Domeowrra�isie+D persam(D)!er tdre to do.such v+�4 sbs+t:ses�bos�a sbali ae1 .
MWW bomb wW we tbts a¢mpthm we imswas ibst sbey an amumbg*A pgomibMq Ica
mpaviror(see Appendts Qe Rules and Reawbstoas fw Vemsing Ceossrrcdm Esyeref"M Eeed•N
In
1.]'J} This bdc of swaersess ollea rcmtts b sertoua problemr.Pardc°b
urJian+ed pcna wLca ie boweosraerb4�
mt tbts case your Band e proceed&Saba amot she mi9oemee pafoa at 16 woull w!d<
licensed Smpmisgr. The Domeonxr sdtet sy supervlsw Y mhlasafe�teaLoostW,
To casts dm the homeowner is fitly swan of UObcr msp=AbTtld4s.m WW segdR m pert
of the perm$spolcadm Om the bameowna wrdly that bLwa medasands the sespmasibilis eta
mpavbm You may canto aneod sad adopt are!a formkcrdliattaa!ac Hess to your=mmmol*