386 Essex St - C of A application - replace upper slate roof Date Stamp
R ", CEIVED
LNOV 0 5 2018
DEPT- C&0rF0Mbd..i:`ba_(Aly
APPLICATION FOR A CERTIFICATE OF NON-APPLICABILITY
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 McIntire ❑Washington Square
Address of Property:Name of Record Owner(s):-38'& Tom; ;� �`�
Owner Mailing Address: o?� _L,�i'j'I�i��'7 � �L I
Descrilition of Work Proposed
Please ggx•o!•hivit clexly.Attach additio»al sGere[.s, as necessary
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Name of A )licanti- �e wner Contr- -- � ❑ actor❑Tenant❑Other:
Signature: `- _ Date:
Tel. #: ,- /�5 ���� 4 E-mail Address: $V/t�1nlAI .7—
Certificate ivill be mailed to the owner unless othenvise indicated here:
Certificate should be mailed to: Name G
Mailing address: T'. Cit
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