15 MALL ST - BUILDING INSPECTION Dan: �l l
Up Df aafEm, .4jag!9arbUSPtte
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Building Permit APPIkatioa For: LoeWoo of"ding
'(Circle whichever applies) Roof, Reroof, Install Siding,Construct Deck,Shad, Pool '
Addition, Altemi/on,Repair/Replace.Foundation Only, Wrecking
Other. w4L/WI r e yW
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
To"Inspector of Buildings;
The undersigned bettby applies fora Permit to build"riling to the hHo ving simu atiaos:
OwoaiName JQAW5 "(S4` Contractor._ Soa(U(ce LWALM
—�—
City� City
State �1 /`r Phone State M/1 Phone( )
Ar'chlow: city of s.lem Lich
Street City State I.Ad
.�Mp tM
State ( ) Hoseemoers Exempt Form_yyes ao
Struftre: (please ) Single Faminily. Multi Family NOgw
Estissaw Cost of job S S� Uo d 3
Will building coolirm to larr! ✓yu
Aabeugoa7_ yp so
Deacriiptiaa of work ft be doae: QlOnIitc.e 1- 11AA s JS
4DrawingiSubmi � Mail Permit to:P�1�.$.GNED UNDER THE PENALTY OF PERJURY
CON TRUC ION T B ' OMPLETED WITHIN SIX MONTBS OF PERMIT ISSUED DATE
Depa:trmmt use only. Pcff*# Z� Zoning
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Pamir fee S
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