30 CROWDIS ST - BUILDING PERMIT APP (002) 1
*Il T-M ffL-E l A?PROVED BY T44E
.W5P XTDFI ,Pf Wfl T_0.A .PERMIT .B,EWG GRANTED
CITY OF SALEM
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No. ` ^ W O �:`� N Date -31 __3
Is Property Located In / Location of,
the Historic District? Yes_No_/ Building �0 CVbu c C <
Is Property Located in V S cm,the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name Ihn -41:�Lhm Gf ll o D 1 U JIL
Address & Phone 0 �'bOU��i C
?
Architect's Name
Address & Phone ( 1
Mechanics Name
Address & Phone
What is the purpose of building? -
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost c2000 City License # N P' State License #
Home Improvement /)
Lic. f� ( d
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: o C. n t A-)(Ai C t��
No. Zcv 0�
APPLICATION FOR
PERMIT TO
LOCATION:
PERMIT_ GRANTED
APPROVFD
a
INSPECTOR OF BUILDINGS
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