30 FAIRVIEW RD - BUILDING INSPECTION Zell
IftST-9E ffL-E8 idD APPROVED BY T44E
.U. ..PFXTOA ,PMDR TD A PERMIT B,I=WG GRANTED
CITY OF SALEM
No. F�`' 'L ��'*\ , Date
��S s ' 1r 11 Ward
\"crrnNE� Zoning District
Is Property Located in / Location of
the Historic District? Yes_No_ Building �, ' �(�
U
Is Property Located in
the Conservation Area? Yes No /
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, 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:
Owner's Name 4ZI-20c
Address & Phone 9r)" :74/4i
Architect's Name
Address & Phone
Mechanics Name
Address & Phone L332 -72
What is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? ,L e 5 Asbestos?
Estimated cost City License# State License #
Home Improvement
Lic. #
Signature of-Appodrit
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTI OF WO K TO BE DONE
MAIL PERMIT TO:
No.`M
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
AP ROVFD
INSPECTOR OF BUILDIN S
i