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6 FLINT ST - BUILDING INSPECTION (2)
C� = i0 -Pli N *W-911[fRA94 lD APPROVED BY TW JUPJ:=B PffIIpR TTl A PMW AMG1 GRANTED CITY OF_SALEM No. Dom, wom ZW6g Olahlct f PAY lacaUd ti — of un FNgo D Nc bUlq? YM No Is PmpMy LocaMd In 00 ConMnMlon Anx? . Ye No_ Permit to: BUILDING PERMIT APPLICATION POP: (Circle whichever apply) Roof, Remcf, Install Siding, Construct Deck, Shed, Pool, Repair/Replace. Other PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS MI PROCESSMM TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build actor ft.to the folk *ing speciflcatkms: OwWs Name Address A Phone 11:K� S 076 ) '-I o 7 - 'O 7 6 S Amhkeds Name Address d Phone [ ) Mechanics Name Address & Phone yos 97 -,3 What N VW F X Ma of bW1tlYq? MOEN cl tfuldrq? W©o M a dwallrq,for how mmy hmaM? 0 h e. Cc v�2o wa bWWq conform to law? Y' A 6 ArbNb{? EdWdW ootl l5 0 0 6 Clly LkW"r shM r C s O2 it -7k "SlIgnsture of Applicant ^' SKIM UNDER THE PENALTY' OF PERJURY DESCRIPTION OF WORK TO BE DONE /� J --_J S1" Flo Or 4W MAIL PERMIT T0: No� `� APPLICATION FOR PERMT TO III-k4e", jeo 'iLoL�tike� LOCATION PERMIT GRANTED 19 VfD INSPECTOR OF BUILDINGS _4 � � � �C,)tntOMYa16LUL C`ma�llaCAMM�O . � • '1JaPaatwae(a��i/tdriel��• aMesa l waead gadvag ///sareLar.6 021 It Workers' Compensstim iamrawn AfRdayk • widl.a prkc4W pba of bmisew an do hereby'cerdly under the paint and psaildo of pa+imya cthm OI am an employer prevuing workers' eompenaadee coveFsds for my eiapleyeet vreekbg on Insurance CeaapalW Polhw Numbw L 1 son a sole proprietor and haw no one working fdr me In a w opadiy. () 1 am a soft proprieter, Reneral Commtsm or homeowner (drde osta) and have bled dte comaiciots Based below who•hays thi following workers' eonlpenasdee polldw Comracaor tamranis Compaq/Po Compaq/poft Number Consraaer Insurance Compatry/Po Ntmisr Contrassor In nuance Company/Poliq Humber () I am a homeowner performing all the work myself. •1 vaerra "SM a pq of 0*AMMM.a be fer.areaa n ON Of ee r M.edtww of alr M 4r ca..rare.calecWm w eM laic o Mann ce.warf At'games.eaar Sarin IfA of MGL 15 1 can 4ae w w WwmW a of oin ap etaadn cecwdaq of a lac of w aai I jo*M aaUw em Bran•wwee, ma ya a m a.aaaia in w is m e a STOP WORK ORDER w a fen of S IooAO a am aoa4ae aaa. Signed this • day of .�ccrseei'Fermittee 6unidtng Gepar[rwen[ �jctnsinf Ecard Seiectmefu Office ric�ith Depsrmer,�