400 ESSEX STREET - BUILDING PERMIT APP f :*&SiAWT qE f*A04gND APPROVED BY T44E
WPFGIOB PP" TDA.PEAWT JMWG GRANTED
CITY OF_SALEM
No. Date
i"
is Pcop"Loam in Location of
tha midoft Did"? Yes V No_ baldimg ?x 455W
Is Proputy Looam In
V a C ramelon AM? Yss No
WILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) 3ooQReroof, Install Sid' g, Construct Deck, Shed, Pool,
replace, Other: a^ 5 �d4er-3
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specdIcations:
Owners Name
Address & Phone
Architect's Name
Address & Phone
Mechanics Name lnq fyld," we E l) -
Address & Phone 65" /A/P Fie �y (97t31 fa3- oiO3
WtW Is 00 pwposa 01 WON? /
mein"of bti*Q? M a dw*&V,br how many fmmW? L
WN bu WV mdomi to law? AsbwWs?
Eawmm am 2-0•Co o My L"m r tJ P` SIw Llow�sa a G S 0 7�!/
Lte. I 362 Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORE TO BE DONE
Foguy'- LvA kQ *&e C-Dwe
MAIL PERMIT TO:
No.
APPLICATION FOR
PERM TO
LOCATION
woo
PERMIT GRANTED
2.0
AP �IOVFD �--
INSPECTOR OF BUILDINGS