GARDEN TERRACE - BUILDING INSPECTION DATE:?(1610�
y �itp D fd�ETTi, SftL�JUErt�
PLANS MUST BE FILED AND APPROVED BY THE
p INSR<ECTUR:PRIUR TO A PKRMIT IB'EUgG GRANTED
sT �� Location of Building <7A t17 T�z,Y+t 4
Building Permi;, Application For:
(Circle whichever applies) Roof,Reroof, nstall Sidin nstruct Deck, Shed Pool
Addition, Alte lion, a air/Replace oundation Only, Wrecking
Other:
PLEASE FELL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PRnCESSING
To the Inspector of Buildings:
The undersi''ied herebyrapplies for11a permit to build according to the following specificati-ns:
Owners Name: 5at_E)'7 A 1 04i Contractor: ff4u%rtoar7e;_jr4t_ Rf:=STbaiF/1u15 , �
Street 'A1 r_ IAKTcF4L 57 City' ShLL" Street /& Azc' Dlt- City / &-l75/P;^0
State t1R Phone (979) -?qq_aqs 1 State t� Phone ( G 0c' I _
Architect: Cg A.rt zADo t/ELz_,=co Attzj. City of Salem Lich r _
Streel L I TTLc-,4+L5cA City M'qp tctlau State Lich Cs o i 6v3yHIP H 1 17q 30
Slate )"1 A Phone (781) G 31 . 4,14 1 Homeowners Exempt Form yes no
Structure: (please circle) Single Family, ulti Farm! Other
Estimated Cost of job T 30 O t
Willbulidiogeonfirm3o�law7_ ✓Ves no
'As 4dsRoa?� es, "'-no
Veseription of work' 'be done:STE4 Re 5 I D E G artpva Tc tR A cc
Drawings-Submitted: __yes no Mail Permit to:
;'Signs of Applies on,$f ' ED -DER THE PENALTY OF PERJURY 0394 i
S4C2 'STRUC`I'MM ft K?LXTED WITHIN SIX (t)�MON'i HS OF PERMIT'TSSU.ED DATE
Department use only:; Peii, t6p/Lot
Permit fee S 3c30
COMMENTS:
No. J4 -2c�p
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
t9
APP VED
INSPECTOR F BUILDING