241 LAFAYETTE ST - BUILDING INSPECTION APPLICATION FOR
PERMI TO
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PERMIT GRANTED
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INSPECTOR OF BUILDINGS
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CITY OF_SALEM
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61NLDIN(i PERMNT' T1ON FOR;
Permit t0:
(Chb whWm wx apply) �CWWbW Dock, Shed, Pool,
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PLEASE FILL OUT L WWY a COMPLETELY TO AVOW DELAYS IN PNXMW G
TO THE INSPECTOR OF BUILDINGS.The und8n4insCl '.
heraby applies for a permit to build aocordl,-q to the tkwbrp
Owners Name ��`ev2 / le i e n C�
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ArchkWa Name
Address a Phone f
Mechanics Name
Address a Phone ( 1
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Siprwtum of Applicant
810NED UNDER THE PENALTY'
DESC1ir1P�10N OF WORK TO BE DONE OF PER, m/
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MAIL PERMIT To. L-o �y P7`� {� 'T