28 HILLSIDE AVE - BUILDING INSPECTION (2) 421111MI lST-6EfIWD4A9 APPROVED 8Y T+IE
-MISPI;,CTD1 PRIOR TIC A PERMIT BEING GRANTED
CITY OF SALEM
No Date 7 /2 O
i
ward
_ Zoning District
Is Property Located in Location of
the Historic District? Yes No_ Building
Is Property Located in
the Conservation Area? Yes_No
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: S'cr^eei-?
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 J K L 0/ AI�D t.
Address & Phone 55' �Y/��i��_ f�i, (FPS-1 3an=•0iOle
Architect's Name /--Ix�
Address & Phone
Mechanics Name
Address & Phone ( 1
What Is the purpose of building? Se q.S'B h c / SCr e e r1 rt o v r P
Matedal of Wilding? If a dwelling, for how many famities?
Will buildin to law? Cf Asbestos? A,1
mated cost /D0D, City License N state License 8
VV Baas lapmVeaent
' Lic. I L2d2— 7
Sim lure of p icant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
14. See-
SG/iCeGj fj0(/SP I�7 �79•GI'C ✓g!i
MAIL PERMIT TO:
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
APP OV�D
INSPECTOR OF BUILDINGS
CITY OF SALEM
BURDING DEPARMM;r
HOUBOWNER LICENSE p�TION
Plase� •
DAUB F L
JM LOCAriaN
F
. 130MECWNM SRN t
ADDRESS
Hoi�aovrmt q"7 Sr :�K 3 6S $ a $
TELEPHOWS
PRESENTMAILII?G ADDRESS
The=not cmnoco of-homeowncif was-MCD&d to brfide
Unbs a lets and r&now sneh homcowacs to c+isis sn bdividasl,
li e,.prwided Om.*e ewsar'aet ns"PuvBes:
DEnN 1ON OF HOMEOWNM to teslik.m.�Oise k or is
who owns a parccl of UM on whkh he/she resides or buerads
Perms(s) dwc a=dr d m dcuded rxrtrmm sO=mq to soeh ma smdkr
9nuaded to M a one m twoho cor RbtL ew s�a%be eond6a d
farm strucnoes.A pettm who constructs trrore thm emc horse bt a two-7 on s lasp seAPubk b lis
a homeownct. Such jWmW%TAr
bk afl sud►weaic pafa+ned mdu Om buOdiK Paa�.
Bw7dbtt OdtCisl, .
Tha 1mdmip ed-homeownaw auras nVomlift la=Wpliw"*j h 6c,Stala Bid Cob and
other appGobk Secs W-isws,mks sad te=u1260M
The ia�da,PW-homo"W' =oSes that helshc widas+ards the a4 of Stalean BnSld{s6 Depoaad.
on >rrss and rcgturcarcres and that hlsls will Wmpiy with said proodmet as
n=mmo btspati proecd
TUsMMCNL
HpAgOWNER•S SIGNATURE
APPROVAL OF B= NG 1NSPECTOA
See other side fm AWC Cade
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