12 FAIRFIELD ST - BUILDING PERMIT APP -r
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.. DATE:
Cttp of aate C, �KaSejarbu5etts
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building �� /IZI=/FGD S7
Building PermitApplieation For
'(Circle whichever applies) Roof,Reroof, Install Sidin Deck, Shed, Pool
Addition, Alterado /Rep oundation Only, Wrecking
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:
II ,// � Home Depot
Oweeri Name: tt.D i 77"� /ti A ZS/-yA omtraetor, 3/5 Greenwood Street
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Street 1. -FAr?-F1fC0 S•r City SACC Street city
State, Phone (924 7VC- 9(09-S State Phoney 78) 5Io9-511"6
Architect: City of Salem Licit
Street City State Lich 'Ps
State Phone ( ) Homeowners Exempt Form le no
Structure: (piease cirde) ingie Family. Muld Family ii Otluc
Estimated Cost of Job S —7, QF00 �41,ao p�
Wig building confirm to law' X yCS no �QY�
Asbedes'_ya_,J�_no
Description of work to be dome:
Drawings Submitted:: no Mail Permit to:x 614l\i N A1.64
Signature of Application,$ GNED UNDER THE PENALTY OF PERJURY T(,j./G 5 goZ o, v✓( A
CONSTRUCTION TO B&OMPLETED WITHIN SIX(6)MONTUS OF PERMIT ISSUED DATE
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Department use only: Permit# J—V� Zoning Map/Lot
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Permit fee S
COMMENTS-