19 CUSHING ST - BUILDING PERMIT APP (003) ;. =
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JO WT-BE f`ILfDiND'A?PROVE0 BY T44E
J1 PACT. R PWR TP A PERMIT BEING GRANTED
CITY OF SALEM
6
Date
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Is Properly Located in Location of q
l 605 NC,� ST
the Historic District? Yes_No� B —�
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, stallonstruct Deck Shed, Pool,
epair/Replac er• 2o�-- w l� do e✓S
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
Address & Phone lq C �SL-,'�� S f may! A' 6-�i7
Architect's Name
Address & Phone
Mechanics Name 4
Address & Phone i
What Is the purpose of building?
Material of building? Wn0A If a dwelling, for how many families?
Z
Will building conform to law? Asbestos? 4
Estimated cosv�—.E4 City License # N State License #
� home Improvement �� C >
g3c06 Lip' IA, Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�FiYrad��� 9c� %eoor paecr� , S_ �o�u 6r A1)C-6�t WrAW
2 J 06 TY'-Q�� Q�
MAIL PERMIT TO: �osSi /9 Cus�%^'a • Iv1►q • o1976
1
No. %
APPLICATION FOR
� PERMIT��Uh�UICI�— ��Cfih� rk
- w L CZ S
LOCATION
PERMIT GRANTED
A ROV�D
I SPECTOM OF BUILDINGS
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