13 Warren St - C of A application for shed and driveway Date Stamp
%..
...its ,;..
its
tE�j
_CT 18 2017
Hi j D PT. OF PLk N 1 r 1 :' -,
Salem lJI sto ca Commission COI (UNITY DEwELC P
120 WASHINGTON STREET SALEM MASSACHUSETTS 01970 For Office Use Oniv
(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 ❑Lafayette Street I IcIntire []Washington Square
Address of Property: 3 W( Ten S
Name of Record Owner(s): yj�j eyN
Owner Mailing Address:�� �Jcv� , 54LLA,., ci 7)
Description of Work Proposed
II Please type or print clearly.Attach additional sheets, as necesswy,_--
�+15 A i7 `AL — �
Ber-cz,,N 4It 'J(ic� If
p► -I�., r u)oej
�:
C_ ;Name of Ap licant: rM Owner❑Contractor❑Tenant❑Other
Signature. w Date: : 77_0
Tel. #: opt-(J E-mail Address: Ir CkA• uj /kcv-�
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address:_ _ City: State:_Zip:
- —4
ILI i
w.e - Y_r
. X r
f