28-28.5 Broad St - C of A application - paint colors Date Stamp
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JUN 03 2019
Salem Historical Commission EPT. OF RLAN,NUNIQ Fk
120 WASHINGTON STREET SALEM,,MASSACHUSETTS 01970 rO M,UFbff-@flfb'DW)C�1��
?9761 619-5685 FAX 1978i 740-0404
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
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 Appropriateness for:
❑ New Construction ❑ Moving ❑ Reconstruction ❑ Alteration
❑ Demolition Q Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street ❑McIntire []Washington Square
Address of Property: 28-28 1/2 Broad St.,Salem
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Name Of Record Owner(s): Leslie Adams and John and Jennifer Michael
Owner Mailing Address: 28 Broad St.,Salem
Descri tion of Work Proposed
Please lope or print clearly.Attach additional sheets, as necessary.
Total exterior painting by Preserve Services with colors as shown below. Door will be painted black.
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Name of Applicant: Leslie Adams and Jennifer Michael ❑✓ Owner❑Contractor❑Tenant❑Other:
Signature: Date:
Tel. #: 978-210-1139 E-mail Address: badams202@comcast.net
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address:28 Broad St. City:Salem State:Zip: 01970