393 Essex Street - C of A application - new sign Date Stamp
f
Salem Historical Commission
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01970 I For Office Use Only
(978)619.6685 FAX(978)740-0404 ---I
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 0 Moving ❑ Reconstruction
ElDemolition 0 Painting C1 Si ❑ Alteration
� ❑ Other
District: ❑Derby Street Uafayette Street ❑McIntire
_ ❑Washington Square
Address of Property. 3 R,3 C
Name of Record Owner(s): C1_"1i k L
Owner Mailing Address: e.c_►�e d
Description of Work Proposed
Please IYPe orPm2t clearll:Attach additional sheets, as 12ecessarJ
Ldok: TO uV U-15") ►ess 7t J;A' o-+ L.oce.T,an -31S (3 T-
w k, I-e- keep, (�►Th►� CTgTOrLq l_pwtr►a �$S�O c�(�� w���efS �t�T
I vtAoke r L&c_cA I o,,-) cq� J-e-%,xL
IeLr-
5'% As a-110VI ree (5)/ "[Pere.4. ra a-vC_(
5 7 i ere oCi.5 170 ,L A; 6 �c
tJ�Ld
La-s�9°nrs 7���.s
Name of Applicant: L6_6 Avn/6 k ❑Owner ❑Contractor ❑Tenant ❑Other:
Signature: Date: 7 esr /-(
E-mail Address: g T, e IL.t&I I 41
Certificate will be mailed to the owner unless otherwise indicat here:
Certificate should be mailed to: Name i ek2 i r
Mailing address: �� City: State:0zip: