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108-110 Federal Street - C of NA application - inkind painting Date Stamp r IIEGEIV ? :m JUL Historical ]i Commission OF PL;INNIN:;1 & Salem ,[! sto _ical �. ommi:tision COMMUNITY DEVELOPMENT _ For Office Use Only 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 ❑ Reconstruction ❑ Alteration ❑ Demolition Painting Sign ❑ Other District: ❑Derby Street ❑Lafayette Strut QMclntire ❑Washington Square Address of Property: Name of Record Owner (s): -r Owner Mailing Address: 1 �. -�e a�.o , �`�. �� ► y0 _ Q��7©. Description of Work Proposed Please type or print clearly. Attach additr'onal sheets, as necessary. IaA tIT � te, JPV-1 � �- VOQ1YYt.2- -- CQr�B 1� L�4 r Name of Applic nt: _ Owner❑Cantr<ctor❑Tenant�Other: Sign79* re _ Date: Tel. -4-0 6 8 �� © E-mail Address: Certificate will be mailed to the owner unless otherwise indicated here: -d Certificate should be moo: Name g address: Mailing add � 0r d -e-Lg, p �1 tate: i ": Y —