13D FILLMORE RD - BPA-70-2004 V ,
1q*W Mu T-MfiL-E { Af1PROVE0 BY T44E
11a SPBCT.OR ,PRXIR Tp.A..P.ERMIT B EW G GRANTED
CITY OF SALEM /
Date /
No. ^I�O� �::• '� -!�'\
Is Property Located in Location of t
the Historic District? Yes_No Building
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: U N*r+ ber�f Do M +o (A 6135
13 roorq
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 A k 4c, L 0 U P
Address & Phone f =,.� i
Architect's Name Al d N f
Address & Phone L 1
Mechanics Name �ll o ptw��4 `T re vAh I e
Address & Phone RziI 9 — L/IL 3I
What is the purpose of building?
Material of building? Si If a dwelling,for how many families?
Will building conform to law? e J Asbestos?
Estimated cost () City License # W/P' State icense,# 2 1
\T Home Improvement
��/ Vv Lic. #
i9 nature of APP lic t
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
T cv� hole rew l cheA, wftl!
�
� I(� l�` bu "o corms ver �I�� roorn
o arNrwof room
i r� sP v
MAIL PERMIT TO: 4 � D �1 �1 OIL' �Cit l m
•t
No. 10 - 2-00
APPLICATION FOR
PERMIT TO
/
fo P f % �o
LOCATION /
PERMIT GRANTED
l//EiI V �J 19
/APY-POVED �ff�'//jl
V 1 3 . .i�(//lrrt.Gi
INSPECT. R OF BUILDINGS