0040 REAR HIGHLAND AVENUE - BPA-6-472 fL�MS1MtISt�E A#WROVED BY T44E
INSP1=08 PNOR TDA.Pf.W JONG GRANTED
CITY OF SALEM
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BUILDING PERMIT APPLICATION FOR:
Perms to:
(Clrcde whWw w apply) Roof. Remot, Install SWXY Carntruct DKK Shed. Pool.
RepaidReplace, Oltter:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undwsiprwd hereby applies for a permit to build aoo xft to the foUowinq
Specificatiom
Owner's Name
Address & Phone
Architw's Name
Address & Phone
Mectwnics Name
Address & Phoned
Wht Is Yw pUMM at WNW
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wo bAft oadwm to law? Man"?
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SowWre of Applicant
SW= UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: e 66/,L�/1
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NO.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT-GRANTED
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ZOF ILDINGS -