95 Federal Street - C of A application - rear stained glass windows Date Stamp
ti j;i
��Y71E tfi!.6-_
Salem flistorical Commission
= - For Office Use 0n1Y
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 ❑ Painting Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street ❑McIntire ❑Washington Square
Address of Property: 9 J� PO4r V" d 'S,rveC- L'�►+t!
Name of Record Omer(s): '-A V t C i c per v a Lc
Owner Mailing Address:
Dese-ription of Work Proposed
Please type or print clearly. Attach additional sheets, as necessary:
t 1,,� i(''l,, 21
(/� e, ✓ v r1 j t7 ►, de w in e t,�Fj �a � t'V! C 5 1 1�C � �x�# ,r��i S
Name of Applicant: c�c �s Owner❑Contraetor❑Tenant ffOther:A",11
Signature: Date: ;;� 11
Tel. #: `] ! a `7 y �"7 3 E-mail Address: k c iG 11 C �;1 Into t� dvo v
Cer4kate will be mailed to the owner unless other se ndicated her®:
Certificate should be mailed to: Name %A v r C 1, 14 - pe
Mailing address: CIS tvq '1 � F 1 � .�Lei-IA P `l
City°: State��'Lip: �..�._,.
t � E
f
IF
i
i _--
L