15 DEARBORN STREET - BUILDING INSPECTION s
y.:
44:Am IfttsT-BE-FfL+G1N0:APPROVEO BY T44E
.ML5PXTDF3 PFWB TP A PERMIT.B,EING GRANTED
_ CITY OF SALEM
/1\
N ir
Date
NIN6�y
Is Property Located in Location of ,Q
the Historic District? Yes_No Building /� ,U,�RK
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Idipg, Construct Dgck, Shed, Pool,
Repair/Repla e. Othe-: 41MUCt Xl-k1iEN
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 6 t // &okdoi5
Address & Phone R h D S7� ( %78� 75/o-
Architect's Name PECEAJ �ID�S or
Address & Phone sz\ln�P9 (77K 7f�� —�`�� J
Mechanics Name 3 eoOct,
Address & Phone /� MH RC-44--/ ` /&( /2/
What is the purpose of building? 4 Cx1 .
Material of building?f1)00 If a dwelling, for how many families?
Will building conform to law? Asbestos? WO
Estimated coA Y/ O U City License # N p' State License # C-S a
X
Home Improvement
Lic. E 1002 `L
Signature o pplic nt
SIGNED UNDER TH ENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
SX /D Rl-l-dg R�
MAIL PERMIT TO: � ��,ZSaf ta�f ��C�reY�f�L19!
h
I,
di
4 1 4�
I 1 54�t
ttI
9 i ii
, �II
NO.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
Al CVP V
INSPECTO OF BUILDING
E I
�✓.� yam) {
(;J1rr"7`r�J If"l---;d'L-3o i
�l ! wi'3,- r V-
ITr 1
r�
_.
117711
] . IL
0emyl
;
Ol
I�~�/-• t fk a1 N�'LLl dd ,..
_y
I -
a'iht- 0i b
f
-�'oi.(�r✓I J .f�Q S d o�r J t Wlr�l ' '����� i , f j f
I
`s.
41
ps
s M9a��aa i �
410V
i
� l ,
My\ /
rl
y
aY7
e�oQh 7 .. �
�I
tea.
ti' � yam
v
i
i
_..._. .___._ .
i�
10
j
1
y _
° _1w_.- t ILU
- - _-
Mi
y