13 JUNIPER AVE - BUILDING INSPECTION I ti
i '
Y
1
try
fLit118iY1h8�'`BEf�.f$�tND OVER BY TiiE
IAL�+FFL7L�A D�31 P SjIND GRANTED 1;
` Ilya:
CITY OF SALEMDab
;
s
Is Pmpwty Located In Location of
ON Hlatodc DWdd? Ys _No_ Building Jtiaa,
Is Maw"Located In ��✓�
WWCoroerwdgnAree4 Yet_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof smof, nstall Siding, Construct.Deck, Shed, Pent,
R , Other,
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCDtllf NG
TO THE INSPECTOR OF BUILDINGS: ~
The undersigned hereby applies for a permit to build according to the folbwing
specifications.
Owners Name /6 l ( �P✓�P
Div
Address & Phone ✓ ( 1 (f ,/�l 1
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone
What Is tfre purpow w buWdMrl? l'�I/v
mde"of fwlldnp4 B a dwe",for how mmy familm?
WE bukbV cordorm to law? Atbedw?
Edmoled Cont. 00�ckv ucwaa e N A son Uomm �(i.
��_Lam. A at ,
Signature of Applicant 1i
r
SIGNED UNDER THE POWOVI „
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Lo.
• j a I
.ry;!II
�w MAIL PERMIT TO I J r
1"
Nr ,SiF!"
x
No.
APPLICATION FOR
PERMIT TO
v er
LOCATION
3
PERMIT GRANTED
AP A VFD \
INSPECTOR OF BUILDINGS
s
3y'�'