29 LEACH ST - BUILDING INSPECTION (4) �L���Ewir� ArMovf3o frY a�E
dos PfW TO A'VMW RZM oRAMb
CITY OF SALEM
Wed
Is
l..J
Lacmd
in LoostIm
r�o Y.. NoJL �u+s.s or ail LTRc�� T
la PIGWIV LOoffibd in
bCarw -'n Am? . YM 4b
f'.rmk 10: GULDM PNW APPLICATION P�
0016 Whi*AWr apply) ROOF, Reroof, MAW gyp, Cvn W DooK $INd, P001�
F(z6YVT Polct' N�2
PLEASE MA.OUr L OWLY A OOYPLET®.Y TO AVOW 0M AYS
TO THE INSPECTOR OF BLMWNOS:
The hei try► applies for a pamik to bAl a000rdE to ft.1min dnO
speoiNoatlons:
Oates Nam.
Addnas A Phone a q al ICU 9 7 Pf-
Mhk@Ws Nan lid tq
Adarees s Phone
Msohanics N. Q0 4:�'C S S
Ad*m A No f503 - 66 q. 7 q38
wo is ft pop=it M~ RCS! OG(U T/t9 b
MAN a MW w o oD e a dw- I for how armor W~
wa bang aa�+onn a wrr 1/ES Ate? 1UD
Eamm ew -AXONCND►Lbr • •
3sbo
Efa. of APakoant
a I --1E - "LTY'
OP POUM
oNMANOWWT>ION OF WORK TO N om
2 ft kG — [?6P&ACr 9 t,hrC-
FPoo n:V Ao 14, t7 A1r s pepm cc 9 mps
MAIL PEFUT
Doti(/ oGCK'/4)
V^
4
4'
Z
run,x rwDrMff UMPARTMOfr
120 YAWHIUW M alreea r 3RD PLooM
sALCK MA 01 W4j
Tat.(070)7411-MM OLT.300
FAa Iti70)7A6aS4s
STANLaY�rLMW4=:g. JIL,
DOPOBAL OF DMMR AFFIDAVIr
h aooadao g wilh the pvviaiaos of MIM a 40.SK i acl wwb dp do r a amdhim
dI dMboo Pamait/ .4 debris msoltio8 Scam the aMWw doe t d ft
pva= d by dds Boo toE Pamdt d and be dtspossd o[in a pvpat Boomed sofid waft
dtspoaai hcI ft,r dsdmd by MOO a IK SISOL
The dabda.vm be At posed Ost A — �7�Ll µ'l 101 Iy 5TG/� �%t���vGv
_ Locaaota[Fadliq►��!
stem.o[Pemi<AwlfaoZ Dar
MUUFULLY caorplese du fbllowhy io�sdaa:
B PilW CLBARLY)
rrtm.atFaoaic Apptioast
Phm Nam%itsor
Ad&u%sty A Shoe
The above stalft rajoitea due debris Sam dw dowlieian,raomadM mhsb ar other
altaratim of boUng or dmcnae be disposed in a popa44icrosed soadAvule dirporai
5a7ty as defined by UM cUL S1SOA,and the bm'Wios pan&or lieeoaee ate b
iaank 66 beadcom aces heft.