8 MAPLE AVE - BUILDING INSPECTION (3) APPROHED BY \1E
MPECIM PWR TTl A PERW BEING GRANTkD �S
7 CITY OF SALEM
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Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) oDf, woo
I Siding, Construct Deck, Shed, Pool,
RepaidReplace, er
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PRoCESSM
TO THE INSPECTOR OF BUILDINGS: 1.
The undersigned hereby applies for a permit to build ac conLmg.to the following
specitbatiorls:
Owner's Name fl v-i�"V r �� -
Address Q Phone 9 M A-P L E � l E- ( 1
Architect's Name
Address d Phone ( t
Mechanics Name
Address APhone MhFLF, floc ,
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Signature of Applicant
SKIINED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
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HOIEOWM9S SIGNATURE C' �—
APPROVAL OF BUl ING INSPECTOR
See otha side for sm colt
HOMEOWNER'S EXEAP'TION
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