3D GRISWOLD DR - BUILDING INSPECTION • nsrl:: 4 - a � - os
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
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Building Permit Application For: Location of Building
'(Circle whichever applies) Roof, Reroof• Install Sidin Construct Deck, Shed, Pool
Addition, Alteration, /Replace Foundation Only, Wrecking
Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings: '
The undersigned hereby applies for a permit to build aaording to the following specifications: r I Owneri Name MLCoc/gf! -B EA IAJA AJ Contractor. -r kO w(,Inc 'i
streets L t rRi,5&)oLn I-)p- City--SAL-614 Street r at woo d) [K,,L) ,4-city Lyw aj
State Phone 3 0 q State -c A Phone
Architect' City of Salem Lic#
Street City State Lic# b_�g HIP# /3 Y n 9 j
State Phone ( ) Homeowners Exempt Form_yes /ao
Structure: (please circle Single Famil • Multi Family# Other
Estimated Coat of job S C D
Will building confirm to law!—LLyes no
Asbestost _ya__Zoo n
Description of work to be done:— 0 F h I A _ k C- C� � o IA 12r�
y
Drawings Submitted:__yeses_ no Mail Permit to:
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Signature of Appl in%SINN�EDUNDER THE PENALTY OF PERJURY
CONSTRUCTION TO B 'A OMPLETED WITHIN SIX MONTOS OF PERMIT ISSUED DATE
Department use only: Peradio Zoning Map/l ot__T_
Permit fee$
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