15 MADELINE AVE - BUILDING INSPECTION -PL-*NS-MOST-BEfILEQ--A+M APPROVED BY T44E
.UN+PFGT,DA ,PFWB TD.A.PEBMIT $Ir1NG GRANTED
CITY OF SALEM
No. V� >t "� A'\ Date I3"Q,S
y
.in J:yyyyyy �
Is Property Located in Location of
the Historic District? Yes_No Building /�/ oftlAlu/&E
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidinja', Construct Deck, Shed, Pool,
Repair/Replace, Other: f/"Nino &rsEt,ar-
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 kIC.dj� t,-'Rlmm
Address & Phone /V{Y"A ueA� ( 97P( 74ScKQ
A Architect's Name
Address & Phone
Mechanics Name
Address & Phone 1
What is the purpose of building? 5),V,->/F rym(j J
Material of building? W dop If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost /S OU, City License r N A �u.-ak sex 9 q3
Home 7mmprovement/ Lic_ , 137y�F;
I I- 1 atu a f Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
a)-w 811ELicir uslw,&wsi a wy,,2&Tf-+61T FINt iw �iJ;Twi 43Z SwFa-f-
24"xzyl broto or-t i4 ria,W alutvlo. HT 7 kbom. TU AC U" d5
FAmrLY QOLY+t
MAIL PERMIT TO: 11m / lA/G &tzMEcl'I-.SYITb0,
96v T 40A rCSr
CxIW04, mR 02 2z(
No.
APPLICATION FOR
PERMIT TO ,Q
LOCATION
l5 hc�,Ietlt,a- .
PERMIT GRANTED
APP O FD \
INSPECTOK OF BUILDINGS