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0068 HIGHLAND AVENUE - BPA-05-574
"Wulf wow# � APMOOVGD all"a J�N�R]>p A'!�N>wr l�Nfi fERAN1�a CITY OF SALEM Do >a�i�lay wmd _ >�� ft! n, " -1� YM ft of M PRpAy LAoolod in : b OOIrM11�011 Am? . Yt_No � PM APPI=Im IOIh Paimk kx Oft middom apply) ROK PAW, WON Bdit OOeadud Do* NW4 POOL er PL EAU PNLL OU'UMLY•CMUMY TO AMM DNNLAV8 N PIIOONrq TO THE INSPECTOR OF BULMM. The undaralpned h Nlby q*ft to a Pam* to buNd aooad'a to ft.1010 -6 p Ora panty Ad*M A Phone (Q c y 7 0 - a 5-L3 ANhho Ce NEW Addw A Plane L, I Adaeaa A Phone 72LI AL 2 ,.0,WL& c9If'y77 q ' ?23 33 wbr r et pmm if bu~ Al 0 klmM d mat a dwalq.for Aon P b111aNt,�_ End=d av t10 • U�• 0 AppNoarK \ UN0�11IIt TY' Of Pomm DRICWIM OR rMQi TO NNE DOIE i�lalnl MAIL PE W I TO: n I.IA'1 lL A&o u( -72-:-h©/- Il 1)ahuen -,�tA dZ�l Z3 A. N J .lyl 'h 4'S...SUP•'iJ 11A it . i l.on�tflWA uuo.Rk/Io/M--a``machwsib � � �lJep..Lw.da�,7aalaiaf�ift��• 600wye�i.�4 Sfwt �esee t f ealsael � //Jeers.& 02111 Cee.asav ' Worken' Compensation Inptrsna A Mdwk . . with.a ptindpal ph= of budeeo an do herebr•cerdy under t1ae palne ;nd pensldn of perjmre than I am an emWl"a prevUlni workers' conWenwdou covepde for MY sis*lerrm woekbg m Insurance CenW W Policy Numbot I ens a sole proprietor and haw so one working fdr an in any oondq. () 1 and a sole propriesore general contrisaw or homeowner (drde one) said hove brad tie con tractors listed below wbo-bnv the following workews' compenaaslon po9dea Coe maw irauran& Company/Po Number Contractor Insurance Cosnpsap/*o NU"W Contractor Insurance Cornpasry/i'oiiq Number 0 1 am a homeowner performing all the woric myself. •e llweayNM ew a CM of di=mom"a of fon+areb ■Or office M M.edtaatwe of Olt M It torware.onandw ewe ea bare a non tontart Al lewlete.11etr Sled"21A of MISt 15 2 tan Mae s at notate of oI i needs coeved"Of 11114 of w M4 IJM=muter w rtan'ieonle,.etel a ya at dd outdo it du bee ei a STOP WORK ORDER awe a bw of s nOOAO a on+Piet sL Signed this • �e/+i X3 day of of eM 5L :i c seciFermittee iiuil'as,"f Depsrtn. t 1Censinf Ecare Ssicarntm Office ricslth Deprmcr,- _ :. •e::, - _ — eeC,r yeC _ eta 40e 40e 175 " ruwc rNOUFORY DpAI"WpR ti 120 VA MUM M swom tl.eRoo11 ' M�aR.MAOta�O SM aTAM.Ir Z. .I..MAVM - - DZIMALCWD�APFMVff Is leooidaeo.wld tb.porydoae othm e 44 tK I .e5oarl�drt tr a.oedYiea pr.vit dW M nmft dft d.aoa�aatiea aelNd4r Apud�►.••d�Ao.d b Ids. d!a a p°�b Ilouto.d.ori waM. • 1br debd.wO b.dt�por./d.e __��1,G1 •. Imm".rlYeil4p aaadlrea�itAppllo . � s . Dr O r1tWc�.en�t' io'°®'d°e NMdPWoWAp~ Phu?Am%Now Adkenc*dtam 7b..bsr..etmt.again.tmt d�ba,yam d.a ar adtr aAw.d.adbaa s b.dbpwdla.pvpabqbnmw dtai V N&&W byUZ eD;SIX&a.d dr bWMo g'&Pad we&d.l.a "dd.heft.