4 LARCHMONT RD - BUILDING INSPECTION i
fL.pM.MWT-BEfN.eq+MND WROVED BY T46E
JAISPJ:CI••LIB PRIOR TPA.PEW REMO GRANTED
CITY OF_SALEM
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i"
IS Prop"LOCEWd in lacatim
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Is Pmperty Located in
Ole cawwvaftn Area? Ym No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, RmQI. Install Siding, Construct Deck, Shed, Pool,
r , Other: 5L-(aerz
PLEASE FILL OUT LEGIBLY 6 COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specificaWns:
Owner's Name dDa r I-e e-y, S4 of o3
Address & Phone q L4, ^� "1' S`(�^ `44(7Y) 7
019�0
Architect's Name
Address & Phme ns L )
Mechanics Name (I'� u4 G 1�11�0 .,S �S� f l/o's-e
Address & Phone �l s (-f���-�' u j ris-) -ZC s- 7.?55
What Is the pwpoae of WddW
mdw1w of bA*Q? 9 a dws&q.for how many familm?
Will bAdhg cordorm to law? Asbestos?
Es*wAed Coy Items r fJ t4 aena I S 3
' � ` X
tse. i lzY�7' Signature of )cant
. SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
2
,
MAIL PERMIT TO:
No. V
APPLICATION FOR
PERYR TO
LOCATION
PERMIT GRANTED
2.0
,a
APP V�D A
INSPECTOR OF BUILDINGS =