39-41 Washington Sq - C of A application - paint colors _Date Stamp
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DEPT. OF PLANNING &
COMMUNITY DEVELOPME14T
Salem Historical Commission
For Office Use Only
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 0 Painting ❑ Sign ❑ Other
District: ❑Derby Street Elafayette Street ❑McIntire ❑Washington Square
Address of Property: 41 Washington Square
Name of Record Owner(s): Jane May, Lacy& David Coviello, Nikolaus Sucher, Maria Caries, Jeremy&Leah Petersc
Owner Mailing Address: 39-41 Washington Square North �.
Description of Work Proposed
Please tf pe or print clearll:Attach additional sheets, as necessary.
Painting front door new color,painting trim around door to match color of arch. Painting stair risers to match treads.
Name of A Barb fa ervier DOwner❑Contractor❑Tenant❑Other:
Signature: Date1-�°I''13�
Tel. #: 781-248-7918 E-mail Address: pervier@verizon.net
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name Barbara Pervier
Mailing address:41 Washington Square City:Salem Stater Zip: 01970
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