2 & 4 FLYING CLOUD LN - BUILDING INSPECTION iiA1l6T�E fIL£B,fMND APPROVED BY T44E
JNrgPFCI'LIB PIVGR TDA.P.EW.SEING GRANTED
CITY OF_SALEM
Daw lFS t3
I .
is Pmpwty Locom in Location
aw Hidafo Diddw Yes.No� Buildina o+
'it Property tacatad in
,ha Ca "mign Ana? Yam_No r
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sldktg Construct Deck, Shed, Pool,
RepaidReplaee. Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersoodi hereby applies fonrl a permit to build according to the following
�'�� �i �fne.,( (sf}(I:SL^mil r�GICXI't✓J�'✓1
Owners Name - "C S�'✓`Z ✓J:�vt�-��c vl
Address & Phone 1 1 1
Architect's Name
Address & Phone J: 1
Mechanics Name
Address & Phone l S-
What Is Ow gapoaa oft' 11 �c i d�C
MWM of bltliditQ? W CU c tl a dwe Wtp,for how many fwa im?
will hiWQ CoFdonn to law? AWD Ws?
cm
F.tWnatad caM e C) `� Cqy liwrna I N P` sumtJcawa r 6 oZA -7`, `7
rv,/l\J 9ar Improwmaat
Lie. 0 If7 c6 7 x -
Signature of Applicant
SsKLMW UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�-SS.:.ice. �-/ec�-I-t'o. - ✓u,.�t-mil.` G ^cj'\. C _ o�,i .
,
MAIL PERMIT TO: I I _) e 'a e • S �. i� <<'-l^*'�r �f 5^
N0.
APPLICATION FOR
/PERM TO
LOCATION 4- e
PERMIT GRANTED
/olds /p f 2.0
AP OVop
INSPECTOR O BUILDINGS
1
y