156 Federal Street - C of NA - painting RECEIVED
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j JUN 22 2016
Salem Historical Commission r. DEPT, OF PLANNING $
120 WASHINGTON STREET..SALEM.MASSACHUSETTS 01970 COMMUNITY DEVELOPMENT
{978j 619-5685 FAX(978t 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 1K Painting ❑ Sign Q Other
District: ❑Derby Street ❑Lafayette Street AMclntire ❑Washington Square
Address of Property: k S 4 Fe�kty�. a t-rtith
Name of Record Owner(s): C,,JAAt
Owner Mailing Address: I eJe,,J_ S t it j e 4+ 0 t i 'I d
Description of Work Proposed:
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Name of Applicant: ZL.y w. W ¢ - ❑Owner ❑Contractor []Tenant ftther:
1. #: E-mail Address: C,L A ►e
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name z 0,46 ci- LA,,vvva4
Mailing address: l Pe A i,,j. C h _ City: State:-kip: ® � �®