19 CUSHING ST - BUILDING PERMIT APP IMIk?VS MU T-BE fiL{QYtND APPROVED BY T44E
WS.PECTDOB ,PRWR Tp.A PERMIT BEING GRANTED
CITY OF SALEM
No. c`t�. ..L �iT^\ Date t 7 d L�
5
aa4� l) Ward
NX ° Zoning District
Is Property Located In Location of
the Historic District? Yes—No Building �� CvS��N� Sj
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, nstall Sidin Construct Deck, Shed, Pool,
alr� Ot er. ���az�ti1
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 f �cUSSi`
Address & Phone 1� c_.t�5/h:?4 `57� ( t) T-26
Architect's Name
Address & Phone ( )
Mechanics Name B
Address & Phone ( )
What is the purpose of building? 7 / / AM N
Material of building? ( 061fo If a dwelling, for how many families? Z
Will building conform to law? (/t'S Asbestos? N f5
Estimated cost 7 5 City License If State License #
Home�. Improvement Li�. I � �
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
iar�� f�lv,h�vvy Sio� � � w / V111V4 f
MAIL PERMIT TO: j C/v 5t,1,y!:) f 1 �� 6 rc-
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
APPjiOV�D
UU
iNSPtCTORC6F BUILDINGS