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3, 7, 9, 11, 13 GRISWOLD - BUILDING INSPECTION
L. iyfliSi �Efl{£�J ;PPROVED BY T+IE IfSpF.CTLfAFlpA IP'A P.EAMJT.S,EWG GRANTED CITY OF SALEM t A'� Date To w, Is Property Located In Location of� �� the Historic District? Yes_No_ Building &I- Is Property Located In the Conservation Area? Yes,_No_ BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) R�, Reroof, aeEr�: �� , Construct Deck, Shed, Pool, 'Repair/Replace, 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: Owner's Namel /l9 / ff CD rS Address & Phone 9&akagys Architect's Name Address & Phone /�1i0✓�T$Ti� ��llrpl %a�i �79�t Mechanics Name Address & Phone - •Q37fD What is the purpose of building? Material of building? If a dwelling,for how many families? Will building conform to law? Asbestos? Estimated cost 9. ' Clty License 0 N A State License N -� �K Home Improvement Lic. / Z� ( Signatur Applicant SIGNED NDER THE PENALTY OF PERJURY DESCRIPTION OF WORK �TO�(lBE DONE a , �9a�'iw Sfiiea�S �f/.Qt`1%��S�`�'y�1��✓�Y✓`�s %/�/a S MAIL PERMIT T0: W `:79P t t NO $ S 2003 APPLICATION FOR PERMIT TO LOCATI©fii: . cry PERMIT GRANTED APPR PD INSPECTOR OF UILDINGS h A� ,p