177-179 Federal Street - C of A application - paint colors f}
RECEIVED
MAY 08 2016
DEPT. OF PLANNING
COMMUNITY DEVELOP em Historical Commission
120 wASHINGT N STHEET.SALER MASSACHUSETfS 0197=0
f978a619-568 FAX1978)740-�ca 4�evdpF c .,
APPLICATION FOR A CERTIFICATE OF -ITY
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 Non-Applicability as described below for:
❑ New Construction ❑ Moving ❑ Reconstruction ❑ Alteration
❑ Demolition Painting ❑ Sign ❑ Other
District: []Derby Street []Lafayette Street XMclntire ❑Washington Square
Address of Property: - /7 e fLc.l S
Name of Record Owner(s):
Owner Mailing Address: eo=1 "T
Descri tion of Work Proposed:
w 5,v e�t(I s
W "140,NJ AID q,
Applications must include photos-of existing,conditions, taken
Name of Applicant:T, R -S Owner ❑Contractor ❑Tenant ❑Other:
Tel. #: ?$-& ? I - 90S-7 E-mail Address: -T. L�4sK14tR1S Q�cr��z.NC-7
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: NameTL���4L rli� ---
Mailing address: t City:�m State/f Zip: 01-,f 1_0