4 LOCUST ST - BUILDING INSPECTION l T-BE FILEDAW APPROVED BY T+IE
.I1�SP�GTpR .PFIJl�IR TD.A PERMIT BEING GRANTED
CITY OF SALEM
Not2"b l ?t� A�\
'� Date
Is Property Located in / Location of / 1�
the Historic District? Yes—No Building ( LDcy5I
Is Property Located in
the Conservation Area? Yes No LI/
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: I?e,.ovn-3oa egth leoam
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 Pz�--7e1 T
Address & Phone + 1-0 / 5 / (9rg) ML 7662
Architect's Name
Address & Phone ( )
Mechanics Namebh
Address & Phone f J ",i Jr rti /V v cy e ✓. ( )
What is the purpose of building?
Material of building? w If a dwelling, for how many families? /
Will building conform to law? c.J, sbestos? /VC)
Estimated cost oub City License # ►.►�P' e License #
Home Improvement
I3c. i
Q� Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
/Ceho/ k�o� i✓cZ?{/I /7crno �12cL A//
/V em, ferS
MAIL PERMIT TO:
No. 316 ^Zoo
APPLICATION FOR
PERMIT TO
LOCATION,
PERMIT GRANTED
J)as�o�
APP VFD
INSPECTO ' OF BUILDINGS
i