0040 REAR HIGHLAND AVENUE - BPA-4-326 i
Pbl I'SIdWT`�E fiL-EffA+ {� APPROVED BY T44E
LUSPECT03 ,PRIOR TO' PERMIT B,EWG GRANTED
Y ,CITY OF SALEM
No,,-I e`v� ` Date
Ward
i \9�cimNrcA' _ Zoning District
Is Property Located in Location O 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:
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 �� (I/(> r°0 ��L r � �S
Address & Phone <��P. �L /� /ter L 4t<--1�2�4- I 2 3
Architect's Name
Address & Phone
Mechanics Name
Address & Phone ram, 4 > -Z-,
What Is the purpose of building? �S
Material of building? ! / �It a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost y&" GGD, City License# 616S� State License # 6 7
Rome Improvement
Lic. i /G 61�jLy
y(� ignature of AppTicant
`<4 / SIGNED UNDER THE PENALTY
t� OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: Xelloe
V - V
D an
w o OZ
-=Au LA
"pBXilbl ho)� . oV, a:"`;r ,`I r4" °, •y,':t:vzt 'd %..psi
i'a� dk "Sa.BG, { tEi C €i
t;+{ `q ` Cs91'a tlr r rda'°,"t<'tiY S✓ti::.
1r-vs'( j'xIvic' i?`90 Kw"llaii 7 ` a.r Ud'- I ;i °i`7ritf#e�3 'fool ! r ?v' iJ !
wN418e33C q 01 rffr -1-5 d t, 10VA ec1T * FlT'3JrW()j b'? Y m;' "., t I'U( ill-
�" t,woif:O flare fi4 '?.? ezitf Jat7' vC� qs tl bvw'+ '€P:},tbnv P.'OT
._,.. ,......._.�:.. _.....,W,,........ . t..,....,.,.L .a.....„.a, .....,.,._........ n. ............ t{�"ev'R i ;#eF",R'a�"1T.7a�l,
P &ag+t`Wk WWI`
'7j l