203-209 ESSEX ST - BPA -2004-1036 INN 11M PROUED 8Y 744E
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-CITY OF SALEM
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BULDMO PEWT APPLICATION FOR:
Pemtk to.
(Grob whlohem apply) Roof, Reroof, Install 8kft Construct.Do* Shad, Pool,
RspaldReplace, Other
PLEASE FILL OUT LEGIBLY 44 COMPLETELY TO AVOID DELAYS M PROS
TO THE INSPECTOR OF BUILDINGS:
The undwsoW hereby applies for a prank tobtdlda000mft to the tokawYip
IF m*Hmmtoxm
Ownses Name JAL,R* TAV,�'��AL&F
Address d Phone Q4&YX* ��"�• .S .
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Am~* Name
Address A Phone �� CSS `�C_ (�� 7S •���7
Madmics Nam �Iley ,I
Address A Phone a0? fed 126 - 55L 3/,5�
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SIGNgD UNDER THII '"*11
i OF PERJURY
DESCRIPTION OF WORK TO BE DPW
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N MAIL PERMIT
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STREET PERMIT
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Office of Inspector of Jguilbingg
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J ermissron fs Sere6y yiuen!o
to occupy for �(//� Y S' purposes
m ronl o eslaleG
of sid a!� of slreeL
.`7�tis permit is lmiledlo' z0�� u6 ec1!o ISre
proursions of lSie ordinances andslalules in relalion to cSlreels andlae.9nspec6on
andGonslruclron of J3ulldinys in I e Gily of c$alem.
Di o!.%o6lbc5eroiees .9nspec/ �21�i(dinys
c$iyrsa/ure ol'.Ap ` / J