261 JEFFERSON AVE - BUILDING INSPECTION (2) fL�MP1611Ab6T�EfILIS#N9 APPROVED BY 274E
JMSPJ:C=PROR TO A PERMIT BEING GRANTED
CITY OF_SALEM
No�� Date
wom
ZW*V DlaMct
Is Properly Located In Location of
"Hisforlc DIOW? yes—No— Zudins 2(s l', ISGl
Is Properly Locded In iJ
the C MOVatloo Ana? Yes No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Rero Install ding!Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY dr COMPLETELY TO AVOID DELAYS IN PROCESSM
TO THE INSPECTOR OF BUILDINGS: '.
The undersigned hereby applies for a permit to build accordwig,to the.following
specifications:
Owner's Name
Address 3 Phone 4-7�r - 7/SS
Architect's Name
Address rl Phone I
Mechanics Name /!�G
Address rg Phoned
tluo/'Ce S'4��— : tlx-
What Is the Purpose of Wn*lg?
MdWW of t>tr~ n a dwoft for how mmY see?
wo teA ft corrfonrr to law? Afteetos? Lloeep
Stft
J
Eaftnitled cost � Cqy Um"e '�
Signature of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: f
C
L
0
No. '� -�
APPLICATION FOR
PERMT TO
� h;z S
LOCATION
PERMIT GRANTED
19
APPF�O��
INSPECTOR 6F dUILDiNGS