16 FAIRVIEW AVE - BUILDING PERMIT APP "4
VED BY 744E
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CITY OF SALEM
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Parma to: BUILDING PERMIT APPLICATION FOR:
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(Circle whichawir apply) Roof, scoot nstall Sift, ConsbW DscK Shed, Pool.
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PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROD
TO THE INSPECTOR OF BUILDINGS:
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Owners Name A, a y4 r -e 1 'v p 10A-
Address & Phone /G 1 1% v r
Architect's Name
Address& Phor» ( 1
Mechanics Name ���Ttrf�ati� / OC oo!`-I y �,v��n e
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7Signature of AppNcarit ';�.,
SIGNF,D UNDER THE P
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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' MAIL PERMIT TO:q;, mil/
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APPLICATION FOR
PERW1T TO
LOCATION
PERMIT GRANTED
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APP�V�D
INSPECTOR OF BUILDINGS
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