5 HANCOCK ST - BPA K
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+STYE f4Lf8liJfl APPROVED BY T*IE
.LNSPXTD-R ,PFWR TD.A.PERNAT BfJNG GRANTED
CITY OF SALEM
No. 4I r7- ?:on � '� '� Date
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Is
Is Property Located in Location of
the Historic District? Yesx No_ Building F� 1-14 v t cue S_
Is Property Located in
the Conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair eplace, Other: W( v
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 :\ l M 2
(� t ti A
Address & Phone �%4"r c,c� J T �178 7 Z g h 6 0 4
Architect's Name
Address & Phone 1
Mechanics Name T.
Address & Phone ( 1
What is the purpose of building?
Material of building? It a dwelling, for how many families?
Will building conform to law? Asbestos?
� '1 � ^ 00
Estimated cost Q�=City License # N A State License# d S 44 R a
j \ Home Improvement v Lie. 1 n o$ it I/►, .weir-I
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE / '
R� in ov 2a 12 L .Qet W 6 I p cuo-ec
MAIL PERMIT TO: cy 6-o LY Co-✓s 7-
1
0 O (
4
t
No. IS-Z pL(
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
10
APPROVFD
20
INSPECTOR OF BUILDINGS
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