32 HIGHLAND AVE - BUILDING INSPECTION Ck 3S3
pL*A1F,VWT. gEfi fa N o APPROVED BY T44E
Jp{$,p==pn1 fl TDA.PESUIT DWG GRANTED
CITY OF SALEM
��'n/ '' Data 5—
No.Iy
it
Is Property Located in Location of
OwHWAftDWft1? Yat No Building 3Z FI-'Sy 1ata >
is Pmpwiy Located in
die CaeanatlOn Ana? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, hod, Pool,
RepaidReplace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AV010 DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name L-e h rl
Address & Phone 3 z 14 st b,a\a raAT (�7�1) 7 N I - d 2.3 ff
Architect's Name N/ 1�
Address & Phone N l a j )
Mechanics Name N/ta
Address & Phone N I P- 1 )
who Is No purpose cl buadirq?
Material a buildup? ,voc #a dw*&V,for taw many lamd"?
Wig wid n cordaryn to law? Aabwtoa? NO
Edmated wal oo City Lkarwe a N A State llcanaa a
some Improvement
L.ic. t /A, Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE 1
_ 114 Z Q i 4av
sl, ✓� l f f�i �'tiC p$ •5� Z_-f tO PT, C7 SfS a (�
eei r d/, '< �'--C- �
MAIL PERMIT TO-
No. j�-
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
2.0
AP ROV�D
INSPECTOR OF BUILDINGS