22 Beckford St - C of A application - trim color I
Date Stamp
R ` 1
NO 142018
DEPT. - Pt A?1tflN
Salem Historical C"ommissioSf MMUNI Y DEy L®P t n
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01970 For Office Use Only
(978)619-5685 FAX(978)740-0404
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 0 Moving ❑ Reconstruction ❑ Alteration
❑ Demolition Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street 9Mchitire ❑Washington Square
Address of Property: 22 Fack-ra- a s
Name of Record Owner(s): Z-j-be-,A + C L' S`",
Owner Mailing Address: J 01—C &4 Aa !4
Description of Work Pro osed
Please llpe orprhit clearlf:Attacl additional sleets, as necessary:
�7
se- 1-.e'x f ze pit if c c,e[Y-A l�� `ram 744- `'-�� 7/ 4-
/'v�✓�C�r- 2 d 1� �S�t c C-�vt..ra�':fii`o— �'K���
D� � .�✓mot;�'/f' , ��� �i y�l� �G r v
i
Name of Applicant: aKner DContractor DTenant ❑Other:
r
Signature: Date:
. Ll o %4, t E-mail Address: < ria-
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip: