229 LAFAYETTE STREET- BPA-06-823 �L11NSitlll6T�BEf11..*q-**D APPROVED BY T44E
1�ISPFCILIB,P'NOR TO A REBMIT DING GRANTED
CITY OF_SALEM
Date
is Property Located in Location of t a S
w Historic District? yak__ _ Building 7�
is Property L.ocatad in
Ore Conservation Aria? Yae No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof Reroof, Install epalf Siding Construct Deck, Shed, Pool,
eplace, Other: (2/to Ae rrFd
PLEASE FILL OUT LEGIBLY rk 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 aaga�i9 ��}Y�/ f9 .Z r ��r�
Architect's Name
Address & Phone 1
Mechanics Name A)r-O 9RQ
Address & Phone A?0-2F17W-,61—ki&Z� (4-9/ )
What is the purpose of bui"? 1 Z"
Material of butidinq? a a dwel".for how many families?
WIN ImAwq cardorm to law? Asbestos? N0
Estimated coat a?�GtY Ueerrea r N P' state umm t
Bowe Iaptovelment $
Lic. t Signature of Apply nt
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
'/ ✓/ rY mil_-`��! /�
MAIL PERMIT TO: �y
.1.
t
NO.
APPLICATION FOR
PERMT TO
LOCATION
PERMIT GRANTED
C�L/3/c 2.0
A�ROVfO
INSPECTOR OF BUILDINGS
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