13 Warren Street application Date Stamp
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Salem Historical Commission
98 WASHINGTON STREET SALEM,MASSACHUSETTS 01970 For Office Use Only
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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 IReconstruction C Alteration
Demolition Y% Painting Sign C Other
District: I. Derby Street Lafayette Street )(McIntire F1 Washington Square
Address of Property: 13 wAWEN 5 EET—
Name of Record Owner_(,):AW-1 FIND MATT C HAtMBf?_S
Owner Mailing Address: 13 MOW&V cfTKOCZ-1—i SA LEM . AIA 0/9 7a
Description of Work Proposed
Please type or print clearly. Attach additional sheets, as necessary.
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Name of Applicant: ,}IMY 64AMBIA-1 Over Contractor Tenant Ofher:
Signature: Date: 9- 3 -20
Tel. #: �7— ��/— ASS 7 E-mail Address: qt !zxb4r bey- e e- iMA#1• CdM
Certificate will be mailed to the owner unless otherwise indicated here: Certificate
should be mailed to: Name
Mailing address: City: State:_Zip:
ATTACHED DOCUMENTATION