26 CUSHING ST - BUILDING PERMIT APP DATE
1
Citp Df �&afem, �Kaoarbuzettz
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED c
Locedonof Building , b �USFI I IVG
Building Permit Application For:
'(Circle whichever applies) Roof, Reroof, Install Sidinggopud Deck, Shed, Pool
Addition, Alteration /Replace Foundation Only, Wreddng
Other.
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings: I
The undersigned hereby applies for a permit to build according to the following specifications:
Owned Name re
://�� l . �((L(S H I TL Contractor. Oiy� F P oT
Street�Qe LtS H I&i& City Street G- ENWOU� City U7o STFlZ
State Phone ( ) Stste� Phone 8)k) �� "Jc? �o (�o
Architect: City of Salem Licit
Street City State Lid! HIP M
State Phone ( ) Homeowners Exempt Form_yes_,Y
Structure: (please circle) Single Famiiy. Multi Family s Other
Estimated Cost of Job$ smo ^ W3
Will building confirm to law'—y—jcs no V=/
Asks"? Yes o0
Description of work done:
H N6rk�4
Dnwiogs Submitted:_des_ no Mail Permit to:g q �) 2lyb
Signature of Application,SIGNED ED UNDER THE PENALTY OF PtikiY
CONSTRUCTION TO B k, MPLETED WITHIN SIX(6)MONTSS OF PERMIT ISSUED DATE
Department use only: Pernilf# Zoning ;Mep/Lot
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Permit fee S
CONKMS:
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