1,2,3,4 FLETCHER - BUILDING INSPECTION 1LA"S1dttST•'6EfiLf1�-CJD APPROVED BY TME
1tJ� EC7L PI IDA L01 PFAJT BEING GRANTED
CITY OF SALEM
Date a3
�4 =.
i w
Is Property Located In Location of (�
the Historic District? Yes_No_ Building A a, 3,V
Is Property Located In
the Conservation Area? Yes No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroo Install Sidin , Construct Deck, Shed, Pool,
Repair eplace, 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
0 1 O
Address & Phone 0946&" 'awi-ll�#3�l i ( Uj ) P32
Architect's Name
Address & Phone cq74 O �3—
Mechanics Name
Address & Phone yliris� ,Sr. `✓�///li`. f/f�1f1, b�i41 8�3 Yy/3
ao�780
What is the purpose of building? ��I✓�z �/
Material of building? �iN/�/Rl/ If a dwelling,for how many families? 7
Will building conform to law? Asbestos?
Estimated cost City License>e N/"' state License n D909, 5'
Home Improvement
kSlgnafuZff'7 LID Lic. II /j3� of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
✓li a
ate
MAIL PERMIT TO: L1 m2oiU 11II$ L7 ;2 o
j
No. '?(,o
APPLICATION FOR
PERMIT TO
LOCATION:
'T4
PERMIT GRANTED
_1. -2-`-(: a- 20 c.D3
APP
R D
INSPECTOR OF KILD114GS
Cl�c6) a