8 Lynn Street - C of A application - paint colors Date Stamp
.%&isioncal Commission
For Office Use Only
A CERTIFICATE OF APPROPRIATENESS
Put -:.L. Chapter 40C) and the Salem Historical Commission Ordinance,
app,ivation.is nereby made for issuance of a Certificate of Appropriateness for:
D New Construction ❑ Moving ❑ Reconstruction F-1 Alteration
17 Demolition Painting ❑ Sign El Other
District: [3Derby Street E3Lafayette Street ,FLIMcIntire E]Washington Square,
Address of Property: .. ?-) L( 4�A
Name of Record Owner(s):
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Owner Mailing Address:
Description of Work Propose
Please type or print clearly:Attach additional sheets,as necessary.
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Name of Applic t: 4owner[3Contractor[:]Tenant[]Other:
Signature: Date:
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Tel. E-mail Address: 2 ma( I [A
Certificate will be mailed to the owner unless otherw h,�r,-�A V.
Certificate should be mailed to: Name iY14
Mailing address: City:—5Am Stat i p:
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