14 Kosciusko C of NA applicationS *le m H istoric *l C sm ntfssrarg
1 20 i#As ii ii'{G-; c'i.":,
;=
-
X'::::f 'H
#sirrs {; ! 3ri
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:
tr New Construction
n Demolition
n Moving
V Painting
E Reconstruction
I Sign
n Alteration
V Other
lWashington SquareDistrict:4"*vstreet Elafayette Street !Mclntire
Address of Property:l'-l HoSci u:i{o s} SeLtrn^ mA otQ)rt
Name of Record Owner (s):t-!1 , c t, nt\ tirn e,R-lr^
lV Hoscio:[/- S+ SeLqfl^un6 ai4)a
Description of Work Proposed:
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Owner Mailing Address:
(-Iprtf Sr\€ * ReP{ntL (roRI^Sh.rn5\Esond P"+".'.q
fn r'"t Sh,rn3ltS, Son,L Co\oceS. rua Ch+nytS.
K t, I \*c t r,r-ovr-'c.TR i vrr Q\^d ?C \t\T .
5A {h. L f101yrr,., S F rrn t Col o ES. 16 (1a,.1q9?S ,
D€cu oeqc+ * RtQe,R rroGvl sT*ias ^na Qn,\ihls.
SAv.t nnc+l.a.aiA\S. fU6 CV.nu,5 tS ,
R t i V"'t FrraC { nnirnT S on\y ,
Name of Applicant' nbqq Coo",*^\ \r nowner nContractor ETenant dotn"Su&$ ow"*O".
,"r.u, q?B-llq-?u*u T ,-^ur oclress: L6o*"llvPc<opere*y.*.*t,ag{*,,*,,r@-J**o.6.+-,
Mailing address:City:State:_Zip: