17 LINCOLN RD - BUILDING INSPECTION fL*NSMRl *E fi fi94A9 APPROVED BY 744E
JMSPECMB PWR TD A PERMIT BEINR GRANftD
CITY OF SALEM
NO. \ Da. 3-a -b S
\ \ ward
,., zorrrq DfI
Is PIOPW in LocatIm of / a the F AM 'rorlc omdct? Yas No x ulms / 7 l r u c o I uJ e A
Is PI*Pwty Located In
the COnravaron AM? Yu No_
BUILDING PERMIT APPLICATION FOR:-
Permit to:
(Circle whichever apply) Roof, Remof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other
PLEASE FILL OUT LEGIBLY a COMPLETELY TO AVOID DELAYS IN PROCESSM
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build accordGig.to the.following
spedficaticns:
Owner's Name _La�224 �r Q i `s h,rJ(D
Address & Phone 7 1, N C 0 YJ
Afchitect's Name G A N Se_r� \o.e e, q Cory S�6)c' -' L dv
Address 6 Phone ( i
Mechanics Name
Address 6 Phone ( 1
WhMlsr»puporaofbWiW k 'IkeY\Xrj f%R2fb EX4L�S,Orj —eOR :�;$ JANA
mdom of butidnpy 1N M a A ft n,for how many Iamarr7
We btddrp canftm to low? XIS ArbrMor4
krallalad coal/D,�00,o O CRY Uum"r slw Um"r
samin
f� .
Signature of Applicant
SIIINED UNDER THE PENALTY.
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: W kQ-SS A 6 o v-e
NO.
APPLICATION FOR
PEEN TO -
LOCATION
PERMIT GRANTED
19
A�P,ISROV�D
INSPECTOR OF BUILDINGS
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)iomwWm.s SIGNATURE
APPROVAL OF BZI ING
See other sik im an cube
HOMEOWNER'S EXEAMON
The code sum tbt: 'av h=Kvwraer prformiraj av*for wrhib a ban pcm h 9=gabed art M
exemp from tir prorkton of Ibis aedow(Salo IIP.0 r Ilocw4 at f.'.OMMAiae Soparwmaao;
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