15 CROSS ST - BUILDING PERMIT APP fL�dI8�Ag6T�EfKA9411ND APPROVED BY T44E
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C CITY OF_SALEM
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Permit to:
BUILDING PERMIT APPLICATION FOR-
(Ckdo whichever apply Roof Remd. Instal Sidira CmrA a Deck, Shed, Pool.
��r -/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSMq
TO THE INSPECTOR OF BUILDINGS: '•
The for it t
undersigned hereby applies perm o build axonLip,to the
speol0oadom. roj 4
Owner's Name &NN)r 5Zoee-7
Address d Phone /S C`f1�ss Sfi 19n 7�iv�l psi
M,hiteas Name
Address A Phone ( I
Mechanics Name
Address 6 Phone 30
What is nr prpm it tNrwtq?
Mftw a allaiq? N a dwaanp,for now many famars?
WE haft cowman to lair? ArOarbr?
F.ranwa coat £sSaO 06 Csy tJowra r slur uoww r f�l�f�/3`j
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\ S of Appl'
SIWW UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK,TO BE DONE '
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MAIL PERMIT TD: %f^ 6 -5r 5 S / " t
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