1,6 HALSEY WAY - BUILDING INSPECTION jdtj6T,•6E fILfO�NG;APPROVED BY T44E
IAl;a14=3-LB ,Pl R `IVA PEBQT BFING GRANTED
CITY OF SALEM
N,
No. 0 o�1 `° �� � Date
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Is Property Located In Location of
the Historic District? Yes—No— Building
Is Property Located In
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof stall Sidin Construct Deck, Shed, Pool,
Repair/ eplace, Oth( r:
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 Name �AM '
/1�i�iQ�/��I�/ 1�//flls
Address & Phone !,SID Ui�CUsr1�r1 TSS /l K;f r`$/) 9 ,gg:Y ?IWA �
••
Architect's Name
Address & Phonespill/1UM 1227 06'i
Mechanics NameHy
Address & Phone
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos? n Y
Estimated cost Oon City Ucense M N P' State License #
Rome Improvement
Lie. I _/J3f�s"ff
2�� ( ignaturepplicant
SIGNED IJND11ER THE PENALTY
OF PERJURY
�r1DESCRIPTION OF WORK TO BE DONE
A'60/�itV - `r0 % ISi l4
ti yStir.S
Olt
'0111A A 11
MAIL PERMIT TO:� `� �D 5 '%IlYI/� /� A"
i
� t
,t.
NO,
APPLICATION FOR
PERMIT TO
SlTf--tor-
LOCATION:
W r:..
i
PERMIT GRANTED
3 19
AP r VFD
INSPEG-TO.FrOF BUILDINGS
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IN
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