65 DEARBORN ST - BUILDING PERMIT APP ' ( ` 1A
1"itlS Mill T-OE ffUEG-ANO APPROVED BY T4 E
LW5PECTDFI ,PRWR TD A PERMIT.B,EW G GRANTED
\ J CITY OF SALEM
Date
Ward
'\fcrmNko� Zoning District
Is Property Located in Location of
the Historic District? Yes_No Building Jo4 e&)2A/
Is Property Located in /
the Conservation Area? Yes No r/
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, roof 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 6u)f- ( Mtt[Anl
Address & Phone ra , 4
Architect's Name
Address & Phone ( )
Mechanics Name Anjmm eras/ 6mr/bw'.de5
Address & Phone �,I 1V,0C7yr,+Id sT A#&,0 V f ( )S3/-(689
What is the purpose of building?
Material of building? 6✓0019 If a dwelling, for how many families?
Will building conform to law? Jr Asbestos? J�(j
Estimated cost L�,GoU. City License#1 6 State -cense # /GT VIf
Home Improvement dJ�
Lic. 110697y err
Si nature of A p ant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: �S� Amlei-W)d 54a-0-1,wo
1 \ ,
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
a 19
AP OV�D
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INSPECTOR OF BUILDINGS
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