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95 Federal St - C of NA - porch and light restoration Date Stamp RECEIVED Salem Historical Commission DEPT. of PLANNING OMMUNITY DE!/ opm, NT 120 WASH NGTON STREET.s For Office Use Only iQ-81..19-5685 F°4 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 Street QMcIntire EjWasbington Square Address of Property: S Name of Record Owner(s): Owner Mailing Address: 5� Description of Work Propose Please type or print clearly.Attach additional sheets, as necessary. 12,a-pff Q V—,g fj�, Lo d-,9 CL e151 f a�A-r — r o(e- r Name of Applicant: IZo ov r �1�9� POwner QContractor�Tenant Other: Signature: 1K WDate: l t Zhw7 -� Tel.#: ,,q O 3 3 _ E-mail Address: zZ k au c�►,�S t. d�e� Certificate will be mailed to the owner unless otherwise indicated it Certificate should be mailed to: Name �j1� Mailing address: e?s_ . , !>ti L-f- y City: f State:YZip: ©1 .'�-.i �•,tn, -�'<L -r a-- !,�.. � S. ,, .�f � x � Vim MJ 17 lk 1 - . i - ; y _ ,�'Yi,�• 4'. 1'y - r,t 7—sr 4• _ — — �y_ - - �� t' + .+_: 4 AA If trio ',�• .1.' � r Y ` 1' 1 I T I f. A - r� 4L r - - -- IN _ �Yl+� Fes`_ r - _„r ``.r�•S,t ..�. ��a�.4. :� �.-"wy<. rayye �, '� �r �, a- ,�'_' � "�7�'•� �� µ f r