1 FRIEND ST - BUILDING INSPECTION -
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�l.ldiSfiAli6i"�Ef�L{��M1D APPFiOVED 8Y '�iiE
JdSPFCIAA,PF310A 7D.A.PEAIdIT aEWG GRANTED �
� CITY OF SALEM
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Is Proparty Locatad In Location of
nw HlaWdc Dlatricl? Yas No '� Buildi�+B /.f i n•ul S i�
Ia Prorarty lontad fn
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BUILDING PERMR APPUCATION FOR:
Permit to:
(Circle whichever apply) Fioof, Reroof, stall Sidin Construct Deck, Shed, Pool,
RepaidReplace, er:
h PLEASE FlLL OUT LEGIBLY�COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies tor a permit fo build aocoriling to the followinq
specffications: -
oart,ers Nema 1y/°/te ��.�. e 6�u c�q2�
Address & Phone L �,�e�.�' S% 1���a �7 Yy— ����
A�nect�s Name �C� �'���tiy ���'�(+�2� ',
Address 8 Phone '� ���.- /� S'� 9�� �a�"6/� G
/f / / Layb�
MechanicsName / JF�n� �'S/�'�y i
Address & Phone S� ��vh+.�-� .�� _ (`�?�� 77Y— av� S' 9
WFW Is ttw purpasa d buildiig? r�frrn� P•
Mtlwlel d buYdinp4 II a dwaYirq� tor how many IemiYes7 � �
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EatlrtWid CObI 0 `/'�a• �%D Clly UCe11Bi� N Ad��iW Lk�Yf18Y k
HOY I�LCv�YIIt �� l_/.(.tii-�J
i'i`. �f�Y�fy X Signature of Applicant
SIGNED UNDER THE PENALTY
OF PER,ltJRY
DESCRIPTION OF WORK TO BE DONE
���C S'�P �� e
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MAIL PERMIT T0: /�,%l¢ �o�c��nc� �-� �i2.'e�v/� ST •5����h,.
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No.
APPLICATION FOR
PERMIT TO
U�yI S �•�, •
LOCATION
PERMIT GRANTED
20
PROVED
INSP OR OF BUILDINGS
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