1 LAFAYETTE PL - BUILDING INSPECTION fL11l161Nl6t�Efll*94109 APPROVE0 BY T4W
ASP==PBIGR TpA.PEAWT WNG GRANTED
CITY OF SALEM
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BUILDING PERMIT APPLICATION FOR:
Permtt to:
(Circle whhttwver apply) Roof. Reroof. Ing" Sidf . CoWn� Deck, Shed, Pool.
RapaWRoPlaoe. Other
PLEASE nLjL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS.
The wwWaVied hereby applies for a permit to build according to the following
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Add("& A Phone 1 LA t&-1 f--'fir= �FL-64 vz (611) 413 21 z-7
Architect's Name
Address 3 Phone L )
Mechanics Name
Address 6 Phone ( )
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U . Signature of t
SMW UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MNL PERMIT TO:
No. . &2-614L
APPLICATION FOR
PERMIT TO //
LOCATION
PERMIT GRANTED
AFTAMP
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INSPECTOR OF BUILDINGS