40 MARCH ST - BUILDING INSPECTION (2) fLANIGIAUSTINEfBsEBM1ND APPROVED er THE
=P==POOR W A PERMIT BEING GRANTED
\\ CITY OF_SALEM
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Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) t'ir'lipkwe,
stall Siding, Construct Deck, Shed, Pool,
Other
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accordwig.to the following
speamostions:
Owner's Name C-Lc x 2 V y G La 0 7— r.
Address & Phone �f uV if l C" /-'(c-', T HTO 7 L/.5 Z7/
Architect's Name
Address A Phone ( 1
Mechanics Name
Address 6 Phone ( 1
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�D THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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DEFOCnONOFHOid AMM
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IiONMWM'S SIGNATURE
APPROVAL OF BSI ING 1NSPE `�
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HOMEOWNER'S EXEMPTION
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