377 Essex St - C of NA application - reroof upper roof - R CEIVD
OCT 23 2018
_= DE T.OF PLANNING A
'?0 STREET,SALEM.MMSAC44USETTS 0 t"D For Office Use On1Y
(9M St9.56W FAX(9i'8)t• -0404
APPLICATION FOR A CERTI CATS OF NON-APPLICABILITY
Pursuant to the Historic District's Act (M.G.L. Cher 40C)and the Salem Historical Comraission Ordinance,
application is hereby made for issuance of a Certificate of Non-Applicability as described below for:
n New Construction Q Moving Reconstruction 0 Alteration
rj Demolition r-1 Fainting 0 Sign 0 Other
District; ❑Derby Street []Lafayette Street clntire C]W ashington Square
Adetmss of 1'raperty;
Igatne of Rec€rrd{)wrier(s); � i� v-,. �rrti V1—
ti
Owner Mailing Address;
Descrintion of Wort*ftggea ,
Please tjpe or print clearly.AUach adr#i`dwal sheets,as nerae s&uy.
0 & d1
Name of Applicant: - L—��"erocontractorTenantoftcr:[_
Signature: �' - Date: I �
Tel.k G} ` r�_q E-mail Address; Yl d� � ah,
Cru+scate will be nwilad to Me owner unless otherwise indicated here:
Certificate should be waited to: Name
Mailing address. City: State:—Zip:
0117
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