2 North Pine St - application - electrical conduit Date Stamp
!'`SS�r III ■
EIVED
Salem Historical Commission R 3 0 2018
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01970 D E P 0 F ftq�4*TSA Only
(978)619.5685 FAX(978)740-0404 COMM
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
Pursuant to the Historic District's Act (M.G.L. Chapter 40C) and the Salem Historical Commission Ordinance,
application is hereby made for issuance of a Certificate of Appropriateness for:
❑ New Construction 0 Moving ')k� Reconstruction ❑ Alteration
0 Demolition ❑ Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street XMcIntire ❑Washington Square
Address of Property: 2 Iv P;pl S-}r e c_t
Name of Record Owner(s): __-w— o �oe-t 1'AA0k Cowctr,*\
Owner Mailing Address: 2 N P ►ne. S rtet
Description of Work Proposed
Please tJpe orpm2t clearij, Altacli additional sheets, as necesmly
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Name of Applicant 04rjp,� Ly wner ❑Contractor ❑Tenant OOther:
Signature: Date:
Tel. #: ZDI 30 9- L1199 E-mail Address: odor e
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name`
Mailing address: �
City: State:_Zip:
AL
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