95 Federal St - C of NA application - rear HVAC Date Stamp
RECEIVE
C
EIVED
t ; JU14112019
11 f 1 1,�2019
�_- DEPT. OF PLANNING & ..ti.��� �+.. �7T—
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,COMMUNITY DEVELOPMEN
Salem istor c al (i1�IZi3ZtS�5ion r DEPT. OF PLANNING &
MMUNITDE��EL�PMEN
;2t'V•t�, `r;Pv,> I STRH1 Y.SA..,.h:', HAS*A'AC 1,S Uf 7C' For OII1Ce USe Vllly
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 Fj Alteration
Demolition Painting Sign Other
District: Derby Street QLafayette Street McIntire Washington Square
Address of Property: _ S- Fiele ivt �s4 t't q,4
Name of Record Owner(s): 1DxJ,ter LUc h
Owner Mailing Address: r`r erod
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
I+h has w�A�1 unAe r ex;S4��1
Name of Applicant: IN,i QOwnerEAContractorOTenantQOther:
Signature: Date:
Tel. #: E-mail Address: .' C 44o
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip: