14 Kosciusko St - C of A application - redesign 3-story porch and stair (002) Date Stamp
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OU 012013
l ii DEPT. OF PLANN;,,,3SalemHistoficaCOMMSSo
nOMMUNirY D EVE LO P N
120 WASHINGTON STREET SALP-M MAS-SACHVC-ETTS 01970 For Office Use Only
f97&t619-5685 FAX(978-1740-0404
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 F-1 Moving Ej Reconstruction Alteration
❑ Demolition r—I Painting ❑ Sign ❑ Other
District: �erby Street DLafayette Street E3N4cIntire []Washington Square
Address of Property: :: Ko5�1UE)Lz=(0 -52--
Name of Record Owner(s):
Owner Mailing Address: 144- ?2m \/I
Description of Work Proposed
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Name of Applicant: Vf 22�C-E, E]OwnerE]ContractorE]TenantWther:Af!�W
Signature: Date:
Tel. #
16) 7 11 E-mail Address:
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: 4 ko�,C i-us V-0 city: �Prb� 4/1�1 State.wAzip:0-LU0-