0003, 0004 HART WAY - BUILDING INSPECTION Sio94iST9EfiL-EB,idO.AffLROVED BY T44E
IAI J JL�R 0,,�IDR ` D A PHRI�IJT .13FJNG GRANTED
CITY OF SALEM
No.
��-20 0 q �° '�� Date
Is Property Located In Location of
the Historic District? Yes_No— Building
Is Property Located in 22—ppp t
the Conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof nstal Sidin onstruct Deck, Shed, Pool,
Repair p ace, 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:
Owner's Name /1l !al� �OrI17�/yl�ll�
Address & Phone „ Iz aeaw#9,wi-aww 1 81) Q3
Architect's Name � �5/I�X '�/�
Address & Phone y57i / � /Iyl1,j� ')�79'�6 ✓L�
Mechanics Name vV*,e
Address & Phone �Las) V!wz
0y, �a
What is the purpose of building?
Material of building? f a dwelling,for how many families?
Will building conform to law? Asbestos?
Estimated cost 21C00,2 City License# N A State License # ��
Rome Improeemen
C_ Lic.
ignatur f Applicant
°I �l SIGNERYUNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
r r OW
/✓ S ` I
MAIL PERMIT TO:�
No. S t -2.o o K
APPLICATION FOR
PERMIT TO
LOCATION:
PERMIT GRANTED
APPR 4-D
INSPECTOR OF BUILDINGS
h
ro M