123 Federal ST - C of A application - replace fence after the fact uate mamp
OF .316
Salem Historical Commission
93 WASHNGTOR `STREET SALEM MASSACHUSETTS 01970 y For Office Use Only
078 ) 619- 5685
APPLICA 'l ' ION FOR A CERTIFICATE OF APPROPRIATENESS -
Pursuant to the Historic Distrs 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 L Moving Reconstruction Alteration
L Demolition L Painting E Sign X Other
efAwe, amd Rglace
District : Derby Street V Lafayette Street *c [ntire ] Washington Square
Address of Property : 2�J � eil�wL '��
Name of Record Owner ( s ) :
Owner Mailing Address : > � � " 1� S�11&: an U r 0
Description of NN ork Proposed
Please type or print clearly . Attach additional sheets, as necessary . _
Name of Applicant: Owner Contractor Tenant Other.
Signature : Date :
Tel . # : E- mail Address :
Certificate will be mailed to the owner unless otherwise indicated here: Certificate
should be mailed to : Name
Mailing address : City : State : _ Zip :
ATTACHED DOCUMENTATION
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