153 FORT AVE - BUILDING INSPECTION (2) IK:AM-MtOST-SEffLf� APPROVED BY T44E
.WSPI:C3'Dl3 PFJJitiIR TO A PERNllT B,EWG GRANTED
L
CITY OF SALEM
Date "..
I it
Is Property Located in Location of \\ ZZ
the Historic District? Yes_No_ Building Is Property Located in
the Conservation Area? Yes_No_ r \\I
BUILDING PERMIT APPLICATION FOR: V�
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: Q�jwc 3
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: L
Owner's Name �/7//� ?
Address & Phone
Architect's Name
Address & Phone
Mechanics Name //�,r2L,4�
Address & Phone
What is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost � City License# N 0' State License #
Bone Improvement V
Lie. / IA1
Ignature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
APPLICATION FOR
PERMIT TO /
LOCATION
PERMIT GRANTED
AP7RDVFD
INSPECTO OF BUILDINGS
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Depwuwat ofhWw& d Acdit b
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600 Watlhinsm Street
Bosom.MA 02111
TeL 11617-72749M ext 406 Of 1-MMASSAFE
Ffic 0 617-727-7749
Reviead 5-164 www mmgov/da