319 Essex Street - C of NA application - reroof a
Date Stamp
VE
,Salem Historical Commission coMMUN Y DEV'ELv��Nr
czo WASHY GTON s?REE L SALEM �,nassacr,usE rs ji97c For Office Use my
,s7; 3 -6,x;�77 ',iG
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 In Reconstruction Alteration
Demolition Painting Sign ❑ Other
District: Derby Street Lafayette Street McIntire Washington Square
Address of Property: 31 C.-I_r_
Name of Record Owner(s): L9
Owner Mailing Address:
Descri vtion of Work ProlRosed
Please type or print clearly.Attach additional sheets, as necessary.
clq��In C 4Ae
Name of Applicant: ��S �C b QOwner3Contractoro Tenant ather:
Signature: Date:
Tel. #: E-mail Address: S CO V�,rI2o-J a
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name I
Mailing address: 3 1 S City: State&. ip: