20 Beckford Street - C of NA application - repair gutters Date Stamp
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Salem Histotical Commission SEP 2 0 2019
120 WASHINGTON STREET,SA'EM MASSACHUSETTS 01970 r For Of &Vse Only
1978:619-5685 FAX(978)740-0404
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 El Painting F1 Sign F1 Other
District: ODerby Street QLafayette Street [TMclntire Washington Square
Address of Property: 2-0 3 ecba 4 St Sc,Le-►^, ►`-f o(ef 7 C)
Name of Record Owner(s): (Fa u( 13 u ►1 ke v- Kf rs fl rt N�ker
Owner Mailing Address: �e ck�`oV c� S fi. Sa le 1�4 A 0/9 -7 0
Description of Work Pro Dosed
Please ripe or print clearly.Attach additional sheets, as necessary:
fCepat'r- p-t- G!acHei-S A>r +he art-ffr-�e haLtse,,
Name of Applicant: K�/'5-f1`h kB u n ee r [EpwnerOContractoUTenant[jOther:
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Signature: Date: q 112 2d 1 17
Tel. #: 3 1 S-- / SAS E-mail Address: lb o ofs 6411 ker tO rf 4 i'/•c o L,
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip:
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