0040 REAR HIGHLAND AVENUE - BPA-4-382 i iq,"S M1W -BE fiL �x£� `?PROVED BY T44E
WP XT0-R ,PRWB TP!,A.PERMIT BENG GRANTED
r CITY OF SALEM
No. / .` srr Date
rr 4,. Ward
i\r'cimnk '^ Zoning District
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, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: &UU 4 /�/Gd� CC-
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
Address & Phone
Architect's Name
Address & Phone
Mechanics Name
Address & Phone
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos? /
Estimated cost 6UU City License : C)G State License #
Lome I Zpr7 me t L
/7 v Lic. f —
Signature of Applicant
�ja a SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: ���� �G'c
s� �//l 5
-0 m O o
Z
Cl) 1 M n
m l b D D
= m
3 �r x,,,GOl $Z �7;r»s r
n
r D D
CIn
O ,6wylv
ry
ja"`Y€ R t x,p";�...�.s�4,;1:_:��"$.0 " 1"tx"d"7�«°' "'d`✓�iv°"�,..?aL„"•wr.
m 1 .`
_
.AIA H,2 T „ . il� 47
to .
.t
t ^x�{y...tri�n���ran V r3"}�¢;-' .,—. . . .
�i . .�k^x.}'�,9. 'i l '.{t M„��.PiOd''U , ti',iii k'ta�V
..S S"iAX�i »'�♦ .._ '}. EN�4` el Y »t Od i��'Rfi�pirJW .,x..