13 INTERVALE RD - BUILDING INSPECTION 4LiliMIMtlSTIBE flL:E' APPROVEa 8Y T44E
.WSPECTDB PWR TO A PERMIT BONG GRANTED
CITY OF_SALEM
�� M
No. .is \ Data
ward
Zoning District
Is Property Located In Location of
the Historic District? Yes No Building 1Uc�Q
Is Property Located in
the conservation Area? Yea No_
Permit to: BUILDING PERMIT APPLICATION FOR:
(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: 99
Owner's Name 64vr J S y g I
Address & Phone O A 1 -7 `I( - 1/9 c/o
Architect's Name
Address & Phone —' f
Mechanics Name
Address & Phone f
what Is the purpose of building? '2e s I lt� F—&l Psi—
Material of building? LJ t—� II a dwelling,for how many families?
Will building conform to law? y e S Asbestos? fJ C�
Estimated co;� sc�o City License Ir state License N
Home Improvement
Lic. ff
Signature of Ap licant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE \
MAIL PERMIT TO:
No. "`
APPLICATION FOR
PERMIT TO
LOCATION I ,,
PERMIT GRANTED
7�d1/o�—r ,s
APPRO D
INSPECTOR O BUILDI GS
4
1
Q'!'Y OF SALEM
BUnZrSGDE.PARTkv M
HOMEOWIMR LICENSE mmAvn0N
PkM Prat
DATE
XBWaTION 1 3 n L 'y
A
HOMEOWM �2 g " -1`f l y .9 qO
TaEPHM
PRESENTbM.II,tt?GADDRESS � - • �
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HOMEOWNER'S SIGNATURE '
APPROVAL OF BMDING WSPECTOR
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