24R FOSTER ST - BUILDING INSPECTION i
� PERW Ag eo eGR�w�
CITY OF_SALEM
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BWLDWG PERWT APPLICAIWN FOR:
Pwmd ux
(Circle whiclwvw apply) Roof. Reroof, Instal SWkig. Corr�tW Dock.�Pool.
Rpw/Raplace. Otl�er:
PLEASE RLl.OUT LEGIBLY i COW U ELY TO AVOID DELAYS W PROCESSWG
TO THE WSPECTOR OF BUILDHa&
The undwa od husby apples for a permit to bind acmrdm to the followvV
&elrl"017 Rd,
r0ei-?ver J
(� f11A)l/i;?,V E o+�cl J� 9�8-»y
Address 6 Phone IZ75f0JJ-d P/4 (97o"') 9217-Z71S
Archkews Name
Address 6 Phone ( 1
MedWsics NNW
Address A Phone ( 1
V"is rn pugxm as krldMp9
ewers d taa~ LA-)00 a dwsrrq,tw how sway Nmami
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ua. :�1�6 "06-"S awn of Applicant
BMW UNDER THE PENALTY
OF PERJURY
DESSCRIPnO/N OF WORK M iBE DONE
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MAIL PERMITTo : l3;ii Dowd TI pej,yers, 1-sw9
0/9073
APPLICATION FOR
PER1/Y TO
Ash
LOCATION
ZyK �oSfiEz SA
PERMIT GRANTED
W
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CITY OR SALXMq MASSACMYStTT!
PUOUC PROPERW ORPARTM[NT
120 VAU NINGMU &near, 2ae P.Ame
l"6W M"GONNNs"S 01070
TtLaftf"* 976-715•aap an. 2ao
PAM 67e-74&9"g
Drtbels Dlaoeaal Fob
Is a000rdaoa with the POVWona of MM CO 3 A a condition ofyour
HuiWbi Pawlt is that the debrL ork AM
sed
of is a pnopady licensed solid waste' i w by MdL L
Chapter IQ 91 50 A.
Ihe debris wig be&posed_[of be
au-' 6-A44 Jolla\ she inC (radon of Fualityl 2vJ"I
Signature of Applicant
Date
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Fahue b sdctie COmpe as m+i*W aadar Sacdon 21A of UM a 134�lamed io yp�aa� mom date}
flue up b SI'Maa aed/ar one year imprifoomnIML ,as weH m ofaimbui peoaldp of a
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I.Board of Hahb L Budding Department 3.C y Town Clerk /.
6.Odwr F.latrleal impodar S.Plumbing Inspector
contact Persoec
PDoae th
Information and Instructions
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y VNha0 as%amaGana is NOT wFIV d 10 o Mlda mis st' awk
(L .a dot Soeme a pamal b bma idver eta)»at p
Ths Otboa otlava>i�woald Was w mint Yoe is advance for yaw000paadot�skoald you have any 4eeatiana�
plead do mt burr 10 SIVV as a e$
The Oaparm en�, x�n0ae lim C a]*of Mass3duw is
Dqm n a t of Iada*W Accidents
Ofga o[Invtdtdont
600 Washington Sued
Boston.MA 02111
Tel. #617-7V-49 09 1-8 7-MASSAFE
617-72
Revised 5-26.05 www.mm.gov/dia
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