2 KIMBALL CT - BUILDING INSPECTION r
-PL-*NS IdOST13E fllL+- 4 APPROVED BY T44E
1NSPFX1D3,PRIOR TD A_PEW"T f3FJNG GRANTED
CITY OF SALEM
?/
No.-1/ �� "`� � Date
seta,.
Is Property Located in Location of
the Historic District? Yes No_ Building =n
Is Property Located in
the conservation Area? Yes No 1�
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) oof eroof, Install Siding, Construct Deck, Shed, Pool,
epair 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:
Owner's Name
Address & Phone
Architect's Name
Address & Phone /
Mechanics Name cc/ //oo
Address & Phone &,r4 �� �✓ 4c�e - 09X1 2LLL3 ?
�.A what Is the purpose of building?
/ Material of building? If a dwelling,for how many families?
V, wW building conform to law? Asbestos?
Estimated cost do G G city Licenses N A state License+►
Boma Improvement
_ s'f Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE I D
MAIL PERMIT TO: zz
f%t 7C A/A
v��7a
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
AP fD
u
INSPECTOR OF BUILDINGS