22 Beckford St - C of NA application - lead abatement Date Stamp
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Salem !l istorit'.6al C'()ii"31i1tI,S'.5ion DEP . OF PLiONNiNO &
COMMU JITY DEVELOPMENT
i W,01AS1 W-37 ON STREE!,SA,.;_RA i s ':-. iS 0 i UIP For Office Use Only
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 FyI Painting Sign Other
District: nDerby Street Lafayette Street RrMcIntire EjWashington Square
Address of Property: 22 s i 5�1+LF-M MPp < 19-7v
Name of Record Owner(s): C. M .
Owner Mailing Address: /-1- ;q^^c
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
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Name of Applicant- �����' ["bwner OContracto Tenant❑Other:
Signature: Date: 4LZSLIl
Tel. #: &/�,OW4' /(-4 E-mail Address: eS.-g44-o-9 P G-s+�; c•��
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip: