127 MARLBOROUGH RD - BUILDING INSPECTION IUMBIMST-9E fKA 9#ND APPROVED BY 774E
ASPJ:CILIii PIER TD A PERMIT BEING GRANTkD
CITY OF_SALEM /
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Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, RoW, Install Siding, Construct ecic, Shed, Pool,
Repair/Replece, Other
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCEU M
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build acxomftto the.following
specificaftw:
Owner's Name A vo fla cz:'. v2 v'ca
Address & Phone 1 :4-7 97bi 7 C/ 3 Sr 7
Architect's Name
Address & Phone ( 1
Mechanics Name
Address d Phone ( i
Whtl 1s to papome ar br o*W
MOWN of buldrg? lur,c,i I a daraN for how msry MmIn?
wo bYdbrp oo ft" to**? Aabapoa?
t.WnaW coat ;tj0(),() . CMy Llama• 8tala llcarw M
tsc. I l i 53/y Softre Applicant
SEM tWM THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT M.
APPLICATION FOR
PERT T TO
LOCATI ON
PERMIT GRANTED
19
APPROVED
,/ANSPECTORDF BUILDINGS
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HOMEOWNER'S EXEMPTYON
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HOMEOwMMOS SIGNATURE
APPROVAL OF BLWING DWECTClt
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