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WSPECTI-B ,PFWR TP:A.PEBMT.BFJNG GRANTED
CITY OF SALEM
Date
s
� NINB
Is Property Located in Location of
the Historic District? Yes_No_ Building �� pL
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) #eEirEIREEacie,
. Install Siding, Construct Deck, Shed, Pool,
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 according to the following
specifications: �/ d
Owner's Name ✓
Address & Phone 7_ CO Cx Z-y3
Architect's Name
Address & Phone
Mechanics Name
Address & Phone �� 5fo� ?t' P✓� (7 �) aY �I �1 `��f 1
What is the purpose of building? Cud Q A✓ C e
Material of building? If a dwelling, for how many families?
will building conform to law?v Asbestos?
Estimated cost od City License# N A State License # I 513
aj�j Rome Improvement
(Z-7 S Yr Lic.
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OFF WORK TO BE DONE
y /n
1t� i D l-5 i nl Ci/� s .L� ✓ lL P �DO f�
v vi &Io0o 6:�C.T7',oy S 2' NSLAlI AleGt
wro
1
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MAIL PERMIT TO: 2 ? S -9 T
11'
,t
No.' J �3
APPLICATION FOR
PERMIT TO
LOCATION.
PERMIT GRANTED
AP VFD
INSPECTOR OF BUILDINGS