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177-179 Federal St - C of NA application - repaint to match existing color AVG Salem Historical Commission MM oYt)"/V, "pMG a 120 WASHINGTON STREET.SALEM.!AASSArRUSETTS 8?970 1,978j 639-8688 FAX 39789 740-0404 3LICATION FOR A CERTIFICATE OF NON-APPLICABILITY c District's Act (M.G.L. Chapter 40C) and the Salem Historical Commission Ordinance, ade for issuance of a Certificate of Non-Applicability as described below for: on ❑ Moving 0 Reconstruction 0 Alteration li+— Painting ❑ Sign 0 Other Street ❑Lafayette Street_ Cld'Ivlclntire ❑Washington Square Y' r(s): y(41 4(4 7ik/( s: 7 &idadA3 r1 Ila- V O Description of Work Proposed: IV a<o ®Benjamin Moore Applications must inphotos of existing conditions, from 1 Name of Applicant: rr( Ift Owner ❑Contractor ❑Tenant []Other: E-mail Address: 4 f kf/>'( OA4 Certificate will be mailed to the owner unless otherwise Indic ted here: Certificate should be mailed to: Name , Mailing address: C t 03 City: � State,_ ip: e�