90 Federal Street - C of A application - storm window color Date Stamp
R--
�. z (
JUL 17 2019
_ 4enz Historical Commission
F Pi At`dNING
52l':t1?Siii .3"!Ct�i S'I'F?E"c!.£At._: i:tN.aS4i'iiUS�: [ EPT'F �����p] NT
APPLICATION FOR A CERTIFICATE OF NON-APPLICABILITY
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 Non-Applicability as described below for:
❑ New Construction ❑ Moving ❑ Reconstruction ❑ Alteration
❑ Demolition ❑ Painting ❑ Sign f2- Other
District: ❑Derby Street Lafayette Street �Mclntire ❑Washington Square
Address of Property: qC)
Name of Record Owner(s): / �Cx
Owner Mailing Address: C T
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
rV.-Ocox— \A�
)V� VIS C�L%,e CLV(�Lv\,III,\/\\-k 'LIN
Name ofA -]Other:
Signature.Signature. Date: -7 r 123 /
Tel. #: t�1 q GI �� E-mail Address: �!�-1 � 'c
Certificate will be mailed to the owner unless otherwise indicated here.•,
Certificate should be mailed to: Name "AI, c \—��vtc�
Mailing address: qo SA . �- City: 5 alc-I State:_Zip: U t`1�
N"
lip t
P
r I