8 ELM AVE - BUILDING PERMIT APP fL"*Atl6T-IIEfMWmMlD APPROVED BY TW
JdSP�CIaB PRIQR TDA.PEAYIT AEING GRANTED
CITY OF SALEM
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is Rommy Lacom in Location of
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BUILDING PERMIT APPLICATION FOR:
Perk to:
(Circle whW*ver apply) Roof. R9W. Install SWN. Construct Dock, Shed. Pool,
RspawpAplace, Other•.
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undwaigrled hereby appon for a penny to build according to the folbwing
specifications-
Owners Nwne 04"o,
Address & Phone rT f/m AIr (115-M j
Architect's Name
Address & Phone L
Media = Name -ZA d,
Address 3 Phone
NO a an PAPM d buWatfp?
Lamm a tfwrolnp4 W- / M a" W q.for now many Wn*n?
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Eatl"wd Clly Wo na r N A stw WW"0
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son bgrawa t x n gI aW Applicant
SIQM LNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAILPERMITTO, a57V(? , ,r�J,tiav, 61')a aj�d?
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No. 12,0 L6
APPLICATION FOR
PEFWIT TO
z Aedar
LOCATION
PERMIT GRANTED
APPROVED
OR OF BVILDINGS _.