4 1/2 CUSHING ST - BUILDING PERMIT APP zr
rq, -PL*M-MMT-9E f4L-E-P JD,APPROVED BY T44E
N .=j�jLCTri-R ,0,WDRTLYA PERMT.13EMG GRANTED
;'PITY OF SALEM
.,IND
No. F
i Date
Ward
N% Zoning District
Is Property Located in Location of
the Historic District? Yes—No— Building C -�kgq
Is Property Located in
the conservation Area? Yes—No—
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) oof, Install Siding, Construct Deck, Shed, Pool,
00�Repairlpa" , Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID QELAYS IN PROCEkSING
(1�,)j it / Pe lactomeqtf Lv;Kdo u)
TO THE INSPECTOR OF BUILDINGS:/v f,
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name eo,(4 L7-er
Address & Phone Pa -�Its (7/s eft/
Architect's Name
Address & Phone
Mechanics Name
Address & Phone
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What is the purpose of building? e-a< Lc��
Material of building? It a dwelling, for how many families?
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Will building conform to law? Asbestos?
Estimated cost City License
Home Improvement
TIC. I
Signature of Appli-caiff—
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK/TO BE D9NE
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