8 ESSEX ST - BUILDING IPERMIT APP C -
�� s DATE: 2��a—�
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR'PRIOR TO A PERMIT BEING GRANTED
Location of Building &D
Building PermicApplication For:
`(Circle whichevenappfies) Roof,Reroof, Install Siding, Construct Deck, Shed, Pool
Addition, Alteration, Repair/Replace, Foundation Only, Wrecking
Other:
1 PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PIMCESSING
h CTo the Inspector of BIn,gs:
ZThe undersigned hereby:applies for a permit to build according to the following specificati—s:
OwneriName:CGlerovi-\y 04vi• K,gyj�S�r• ,� Contractor: 4walrC'vi�oh, 61�J c_
Street ESSe>' Cin'sijlye Street8 Ciac/e t ity Pr.460y0,j 41
State Phone ( ) State/ + Phone (5y,e)
V Architect: X�J� /clay jyot City of Salem Lick _
treel (�c_ s lid%e/� S/ . Cily-(� State Lic4(0G3$2C-HV q
State/ Phone ( ) Homeowners Exempt Form ves_,4_no
Structure: (please circle) Single Farnily, Multi Family q Other Z g iv nFFicr
Estimated Cost of job S �aaeO'
Willvbuildingconfirm�o'law? yes no
Asbokos? . es . -oo n r^
Deseiiptiori'of wo t be done: f2ti y4 Li OF i 5 / /yam�� Y& /r
/ ��v t✓
Drawin S'S b e : �yes no Mail Permit to: AN
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Af
Si a of A hestiom? EED i;-DER THE PENALTY OF PERJURY
"CQiVSTITtUCTIQM TOJft LETED WITHIN SIX(6) W1ONTHS OF PERMIT4SS1,VED DATE
Department use;only ;Pell q+� Zgning Map/I at
Permit fee S ..'`�
COMHENTS: '
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APPLICATION FOR
,pp PERMIT TO
LOCATION
' SSE S
PERMIT GRANTED
19
A / ROVED
INSPECTOR OF BUILDINGS