361 Essex St - C of NA application - replace storm windows Date Stamp
r
DEC 12 2019
11 f 4 U N P T. 0 I T1 FY P D tA
EV E
Salent Historical Commission 0 M 1. LO N-vll L t)T
"!qA3 G'-,C)i,<F'!R F.- S A L 1-1,!, Hu"GS I;Z._.:i�0 i 2711 For Office Use Only
i9781 619 Fi,), 97E)% 114041
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:
r-1 New Construction E] Moving Reconstruction Fj Alteration
r-1 Demolition Painting Sign [:] Other
District: n Derby Street []Lafayette Street E(McIntire nWashington Square
Address of Property:
Name of Record Owner(s): Y
Owner Mailing Address: 21C I Se).
Description of Work Proposed
Please type o_rprint clearly.Attach additional sheets, as necessary.
i 4m5 4-t yy\e) I o I ao,
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Name of Applicant: n-Virc P--er-n,\A)211 gOwnerQContractotoTenant[]Other:
Signature: Date:
Tel. ?)It q E-mail Address:
Certificate will be mailed to the owner unless otherwise * dicated here:
Certificate should be mailed to: Name— 2--jr, f L ler,n
Mailing address: City: State:—Zip: