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Cr Y OF SAlEM
BUILDING DEPARTMW
HOMEOWNER LICENSE E)MO'IION
PINK Pda
DA�+t '3 /vA ✓do 0 y
]OBIACAT101f # Tc i rvi STti1cfc 441, 0 974
. HOME arr>at �FciriT Sntr,� SAc� �rt9 aiS d
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PRESENT>,eAaartoADDAE� #�fGi.�.T S��'�r's!4C�i iLPJ' o/s�
Tbc cmrosl.stamftias d-]wmea+�ges>i-�eacaded to b¢lde"vcT-sl mo"dwa6P @tTm
Unlit a leas aid a allow snch bomeowsers to atiaic sit bdhldglfor hats rho does as possrss t .
liocase,provided rhea tbs;wnar'aet d .
DEED nWCF}ONZOWIf
Person G)who owm a Pawl d bmd oa wbleb he/she resides a brands b resift m wm& k�
intaded is be.a as w two familp dw MaS saadmd a dcndrod strucmma ae4 be 000sidasd
farm arncw m A pcnm wbc eortstrueu mom elan ame home iA a ewtrYm Pc&d
Banding omck th UMK be nspoasibmall to&wai�FQfamrd b�F1��
The tmdasipwd`homeow+e sss mrs*o+poru%ft for tamPflw=with*C Sate Bnnft Code md
otba applicable Saes b74rw4,rules sad aSnhdaft
The nadasipssd-iwmaawmea"txrdLes tt u behbe m dc=nds the City of Salem BWWbg Depwome.
miaimmm bapwdtm Fo=dwa and ngmmmcros and sbat Wsbs will mm*wiek said pioowwu and
HONWWNFR'S SIGNATURE \
APPROVAL OF BUADING DWEICTM
See other side for sass code
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HOMEOWNER'S EXEM MON
The code sues IbM 'wW honwcw•ae pafwminS-iv*for whkb a building petmti Is tsxtabed a6a1 tie
e,=V tramdw pv►ak=orlith section (Scatm lip u-13ecasiaS ef Comneettaa Swpervbw$;
provided to b a homeowaa espies!Pam(s)hr b6e to do.mA wmdi6 60 amb 6omeowaa s6a1f spat
. m aaparirarr' •
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n7crybor(tee Append6t Q.Auks and ReSutatfow for LtecoataS Cenatrmcdes SopervfseM Seems
•2.2Q6 This huh of ay.arenera often UFdU in aetiers yeobtems.Pm'tfeo dw I R ' A w.bbM
a Jkcnud persons In tbb case your Band — - a proceed apitst See mioexmev papa a ltw- va
Ikcnsed Sapavisa. 76e homeowner acting as su jvinr b r Wwwri*rn
To enwre dun the homeowna L fttily aware cthtlha responsibilhick many eomamdda* :as prA
of the perudt application.that the iwmeawna a aft that b&WA nndeartands the aspombuldn tit
supavisoe; Yoo may are to amead sad adopt are6 a lambcrdfiadm Sartre in yoar oo0m01116