25 Chestnut Street - C of NA for fence replacement I r�4T
RECEIVED
APR 0 6 2015
DEPT. OF PLANNING &
Salem Historical
Commission COMMUNITY DEVELOPMENT
120 WASHINGTON STREET.SALEM.MASSACHUSETTS 01970
(978)619-5685 FAX(9783 740-0404
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 CrIMcIntire ❑Washington Square
Address of Property: Z f cH`S- -p v r- S r
Name of Record Owner(s): e0-V JA-w w 9='rT%F- if u�
Owner Mailing Address:
Description of Work Proposed:
itf LA-e— r I ist" r�, ® 1= j0tG1t-crf^ rA:Fv e&
i t✓ 1QG A a- tv IF' A-e v SCE . (Lf►N4 V G S t4A a.1_ .Sr=—c
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Lf o e rLy v N rrnAe-T-j jL5 .
Applications must inc • ' photos of existing conditions, public
Name of Applicant: fA L I- A• 04 59*0 RWner ❑Contractor ❑Tenant ❑Other:
Tel. #: nl"7 �- 7��l - 0?-7 L E-mail Address: r Ace,-S pp & ^ Os,-4
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip:
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Salem, MA 01970
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