166 FEDERAL ST - BUILDING INSPECTION i
APPLICATION FOR
PEMI TO
LOCATION
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PERMIT GRANTED
APP OV�D
4OFWLDINGS
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fbWVSl W4@EfNA9dMID APPROVED BY THE
IWPZC=PWo R TD A.PlE9WT WJW GRANTkD
CITY OF_SALEM
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BINLDM POW APPLICATM FOR;
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PLEASE FILL OUT LEGIBLY i COYPI.ETELY TO AVOID DELAYS W PROCEBBM
TO THE INSPECTOR OF BUILDINGS: '•
The urldarsiprred hereby applies fora it to build aocordi;P� gyp,to the
almaw bom. io�Nowirq
OeaWs Name
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Address a Phone
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�nadane of Applicant
Blom UNDER TM PENALTY
DEBCW RK PT11ON OF WO TO BE DONE of PEawRY
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MAIL PERMIT TO: