343 LAFAYETTE ST - BUILDING INSPECTION h
IM--* S MU T-BE f4LfG-AN0 APPROVED BY T44E
LU5PXTOR ,PfflDR TO A PEHNllT BFJNG GRANTED
CITY OF SALEM
. ��NmT�.
No. \ Fte o�\. Date
5
Ward
\�fcrmNE Zoning District
Is Property Located in Location o
the Historic District? Yes_No Building 3
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/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 Cu.r lr'/f ca C(!tc l k n
Address & Phone to 6U4,* are, W;11) 7Y6 3-?3 c
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What is the purpose of building? 3lrhi l�.f
Material of building? ell)a od If a dwelling, for how many families? `3
Will building conform to law? K-5 Asbestos? A,e,
Estimated cost �gg 400. o'er City License# State Uicerl4e #
d b a Home Improvement
Fs Zzz
"""� •"'`� C. Lit. i 13} i nature of Applica t
t S'Z ClwMhyS�. Gr `D $�s1 v5
G.Ieu,CR.e�-w, wyp etg3e-►�K SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: G/!✓DSO ���N/✓ �Dl.�n/ �,
1.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
APPR V�D
INSPECTOR OF BUILDINGS
AUG. 5, 200410: 31AM CHOATE HALL & STEWART 6172484000 NO. 768 P. 2
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t Is , 4IFY of
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I Selectmen Office
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