15 1-2 EAST COLLINS - BUILDING PERMIT APP JACKET -fta94QS9lAW T- EfiL-Ell-�irD APPROVED BY T44E
.IAIBPI=CT .R PFWB TP A_PERMIT 1fJNG GRANTED
L.
CITY OF SALEM
No.�_ V Date / 5
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^W111N6 .
Is Property Located in Location of l
the Historic District? Yes_No_ Building
Is Property Located in
the Conservation Area? Yes No
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 c 1 C
Address & Phone 697X7VV
Architect's Name ��iJYI P
Address & Phone ( )
Mechanics Name
Address & Phone (
What is the purpose of building? 14,o e n
Material of building? 0 �?S C�� If a dwelling, for how many faam.)ilies?
will building conform to law? Asbestos? 'v v
Estimated cost ity License n N A State License 8
Horne Improvement
Lie. /
nature App cant
SIGNED NDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
.t
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
��3/O�tt9
AP ROVED
_
INSPECTOR OF BUILDINGS