15 DALTON PKWY - BUILDING PERMIT APP s
APPLICATION FOR
PERMIT TO
atc ��.n
LOCATION
PERMIT GRANTED
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P TOR OF BUT. NGS
-PL9AM1*11Sfi-BEfILf {� APPROVED BY T44E
MPECTOB PWR TAD A..PERNllT.13FJNG GRANTED ��t
CITY OF SALEM
No. ��`' "� `` � Date 10 2,')
Ward
s
� mne'y°N Zoning District
Is Property Located in / Location of
the Historic District? Yes_No �/_ Building
Is Property Located in /
the Conservation Area? Yes No v
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 I�Ae`e�A�CG���� Ol �,je W 3 1`�-"
Address & Phone 1 ICA\ -WH 0q-13
Architect's Name
Address & Phone 11 ( 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? Lk E� Asbestos?
Estimated cost I'S1J,00 City License# 1 J-61 State License # Q 1 Q(n<A�
Home Improvement
Lic. i 10w 95s'
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: