8 Lynn Street - C of NA application - paint inkind (002) Y1
Date Starnp
isioncal Commission
i
For Office Use Only
A CERTIFICATE OF APPROPRIATENESS
Pur L. Chapter 40C) and the Salem Historical Commission Ordinance,
appucaLion is hereby made for issuance of a Certificate of Appropriateness for:
❑ New Construction ❑ Moving ❑ Reconstruction ❑ Alteration
Demolition fainting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street 4DMcIntire ❑Washington Square
Address of Property:
Name of Record Owner(s): -
Owner Mailing Address: A JAL&
Description of Work Proposed
Please type or print rIcarly: Attach additional slicets, as necessary.
VVC) red
�5 VIA Ups Q Aj,� SU15-T S21�
Name of Applic t: Owner❑Contractor❑Tenant❑Other:
Signature: ^ ' r ` Date: I
Tel. #: E-mail Address: 2 Wd _
Certificate will be mailed to the owner unless otherwis i c ' a . her
Certificate should be mailed to: Name MY
Mailing address: City: lJG "f Statflkzip: