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10 Hamilton St - C of A application - enclose porch Date Stamp r �9 Salem Histofical Commission 120 WASHINGTON STREET,SALEM.MASSACHUSETfS 01970 For Office Use Only (978)619-5685 FAX(978)740-0404 APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS 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 Appropriateness for: ❑ New Construction ❑ Moving ❑ Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Sign ❑ Other District: ❑Derby Street afayette Street ❑McIntire ❑Washington Square Address of Property: vv%,( e\ S�-T QA� Name of Record Owner(s): Owner Mailing Address: 1 �ah�W«� '�� S S M Description of Work Proposed Please type or print clearly.Attach additional sheets, as necessary. y Name of Ap licant:A' k �_cL�-Te f f-,( _ ❑Ownerecontractor❑Tenant❑Other: Signature: �►�' Date: Tel. #: g761", _7 5 c 60 E-mail Address: Q��•� Q'" � - Certificate will be mailed to the owner unless otherwise indicated here: Certificate should be mailed to: Name VV1 th a0_L C'C)�'rQ L�0) Mailing address:•t 11 AJO Suck Z 1 Lb CityLynn Statekkip: ©_E45_