540 LORING AVE - BUILDING INSPECTION LATE: s
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Building Permit Application For. Location cl Building (\ uo
'Circle whichever applies) Roof,Reroof, Install Siding Construct Deck,$hod, pool '
Addition, Alteration, Rgmk/Peplace,Foundation Only, Wrecking
Other:
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
To the hq=tor of Buildings:
The undeksigned hereby applies for a Permit to
to build amordiog to the following ai=Wadm: y-��
Oweerti Name: C�n h#—i)U�1� Contracttoor. C—VL 1 Q - AJC-i I Y, . .
Street_ Z0 (�RI(�Yr hcity /� , Street 2S dY�gl C e
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State Phone ) Slate Phone((oM CID 0 d 0
Architect: City of Salem Lict(�---VIA
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Streetzn�7 city State Lin#—L?ZR--Zf-77HIP r 77
State Phone ( ) Homeowners Eumpt Form___yes ao
Structure: (please aide) Single Family, Multi Family N
Estimated Cost of job S pDc�
Will building coofltm to kw!�yes �
Aabeatat�yea�.so
Descriptiaa of wortk to be done:
Drawiop Submitted:,__y no Mail Permit to:
Sigwdrre of Ap NED DERTHEPENALTV OR PERJURY \
CONSTRUCTION TO BI
1COMPLETED WITHIN SIX MONT$S OF PERMIT ISSUED DATE
Department use only: p
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Permit fee T G
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