4 KELLEY RD - BUILDING INSPECTION f1lMISi�Atl6T�E ApPROV60 BY 774E
juspz W PWR 10A.PEffi f MWG GRANTED
CITY OF SALEM
No. DAM
Is Property LOGSW in / Loaafln of /
Yrt FYtbrb DlMrioi? Ytr No_ aoi]dioa lec
Is Plopm=y LOGINd In
ft
Cmrsrrsepn AM?
BUILDING PERWT APPLICATION FOR:
Permit to:
(Clyde whichem apply) Roof Install Siding. Constnx t Shed, Pool,
Repau/Replaoe Other- L, 4� P7ec ti. I�
T_'
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSWti
TO THE INSPECTOR OF BUILDINGS:
The undwa geed hereby applies for a permd to build according to the following
Owner's Name [Au(tecLnne Cme��l
Address s Phonea—
Archdads Name
Address & Phone ( 1
Mechanics Name 1R/e /T r rr Y ,
Address & Phone /9 Xr l/T y j fle 1
wrrt is ft purport ad b~
mdww of buYdYq? 9 a dwearv.for how mmy Ian bu?
wo b A ft Gordon to law? Asbsfts?
E Wrrstsd and 000,00 Cuy umm# N A mm u' w r�DS
mom Lqmwmmt
Lie.
aL��
SoWure of Applicant
SW = UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
I i II I ,�II
ry-v .
MAIL PERMIT TO. / 9 lee-
// y /?d Su /•• , ��+ .
s
NO. 71
APPLICATION FOR
PERMppGeue eeppAI�T,eO
LOCATION
P��E��RMIT GRANTED
lUwe�rderL z� _ Zb 6 s�
AMTVFD
OF BUI S
1 .—