2 MALM AVE - BPA-2004-156 IKAAI#SlAtST- E f UEG- d0 !APPROVED BY T44E
,WPfXTD-R ,PFId11R TD A.PERMIT.B,EWG GRANTED
CITY OF SALEM
° Q� s-o
No. L 56^ 2��� F:`� p \ Date "^
Is Property Located in Location of //
the Historic District? Yes_No X Building Z /f/p? A�
Is Property Located in
the Conservation Area? Yes_No X
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, tall Siding, onstruct Deck, Shed, Pool,
Repair/Replace, Ot
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: II II , /
Owner's Name �2 b h I e- //p !,
Address & Phone 2 1221a /Pl ( 1
Architect's Name
Address & Phone ( )
Mechanics Name 6&6) 'Sr
q1$ lS- YS� 1
Address & Phone ? zd( ))'c yC,^j-r- Zv (//9��) /)uS-- Zz9 0
U�What is the purpose of building? C S 1
Material of building? 11/6 y-,V a-r.-c_ If a dwelling, for how many families?
Will building conform to law? �zeS Asbestos? A-40
Estimated cost 6SpO• oO City License# N A State License # n 6 ZZ
' Home Improvement X
Lic. i /1L45ignature of Applicant
c SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
a:
MAIL PERMIT TO:
i
No.' ► 5-(:? -
APPLICATION FOR
PERMIT TO
LOCATION.
PERMIT GRANTED
APPROVFD n
AL
INSPECTOR OF BUILDINGS