53 LARCHMONT - BUILDING INSPECTION gPWG1ftWq6EfKM54M APPROVED BY T44E
JMBPFCMB PWR W A PMW BEING GRANTED
CITY OF SALEM
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Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Remof, Install Siding, Construct Deck, Shed, Pod,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCE=m
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applbs for a permit to build accorcLig.to the following
Specifications:
Owner's Name PAT21 GI A
Address d Phone '53 LAPLC4Moi-JT IR-D (-c-)a 1 -741 -3l, L Z'o
Architect's Name
Address 6 Phone
Mechanics Name D'Go,-�,reLA- 2L-UNA&i ,.-16
Address A Phone S X tAE:" ( )
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801dure of Applicint
SKiNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAUL PERMIT M.
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APPLICATION FOR
PERMT TO
LOCATION i
PERMIT GRANTED
19
/INSPECTOR OF'BUILDINGS
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