1 LOWELL ST - BUILDING INSPECTION fLSN61111l6TKfKAWO ID APPROVED BY TW
ASPFCM8 PWR TD A.PERMIT ARING GRANTED
CITY OF SALEM
oft
-i 1-
�'' ww I
zarnp omid
16 PIOMIY L0001Ad in
ft Wpor@ MOW Yas No� Location of
01duims /zIneey/
Is AQW&y Loan+in
aN Comm on Ann? YM No
Permit to: BUILDING PERMIT APPUCATION FOR:
(Circle whioheVer apply) Roof, Reroof. Install Siding, Construct Dell. Shed, Pool,
RWaiNReplsoa. Other rsoVAt� 13dr�r-w,Ccui
PLEASE RLL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESSM
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby aRAm for a permit to build accorcLV.to the following
speorNrreNons:
Owner's Name Vii)n v �1 L(�
Address & Phone I (`-1&j 7.' 6647
Architect's Name 's
Address d Phone ( 1
Mechanics Name 4im 6 0(.. fj 0 �
Address & Phone ( 1
Whet aft parpoaa a tx k*W )2 5 l r,)L3jG E
MMMw a Wo? w30 0 n a d ' Wtg,ror haw m,ny fam2n? I_
WE b Aft awona to how? y Ambm w.? h1
BUNN cost 15 D o U ply l We M 8lala lJoww•
QRS'°` no= relto.�.se
S ature of Applicant
SIGNED UNDER THE PENALTY'
DESCRIPTION OF WORK TO BE DONE OF PERJURY
N 13�?N �1 UaVv� 1 � t U h1bYL� Izoo k ,
MAIL PERMIT TO:
i
APPLICATION FOR
PERIwT TO
LOCATION
PERMIT GRANTED
is Zoo,
APPR V�D
�l
i OR OF INALDINGS