5 LARCHMONT RD - BUILDING INSPECTION r
jdttSi'-BEf4LfQ-ANg0;�,.;`�PPROVED BY T44E
I T,IB F_PJM
,i+i pA 7p PT 6,EWG GRANTED
CITY OF SA'LEM
No. f �J -Zp p Date
t• 1 w
Is Property Located in Location of /
the Historic District? Yes—No_ Building e`7 ZAy�c nyeZ'
Is Property Located in
the Conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Rer of Install Siding, Construe Deck Shed, Pool,
Repai 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 ?6a F, Mary h»1cl9TgCn2Y / n/C�i9Mia9.i�ryJ
Address & Phone A2
Architect's Name /V
Address & Phone J /7 1 1
Mechanics Name is e w R (�rL4c-- s
Address & Phone q a '7
What Is the purpose of building? ZI
nn� (Js�`nR
Material of building? f(, i —11lit/ek!F If a dwelling,for how many families? 3 ,D a\
Nil building conform to law? Asbestos? J
Estimated cost /�bdv. City Licensee N A tense e 3
O�2Sr Home Impr'� //ovvemenjt__ v
Lie. 1'1' r/►\ Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
{.R
MAIL PERMIT TO:
i
q,
't
1
NO. 13-2.-o U
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
AFOROVD
INSPEC. QR OF BUILDINGS