135 Federal St - C of A application - rear fence Date Stamp
77.
t d'.:: �
'L-4
�� 0 T 17 2017
o • o �
alem Historical �'OP?ZMission , �r O t r -� r,��.)
120 WASHINGTON STREET.SALEM,MASSACHUSETTS 01970 �T Y p& euS "Cwy
(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 0 Moving Reconstruction 0 Alteration
❑ Demolition ❑ Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street ❑McIntire El Washington Square
Address of Property.
Name of Record Owner(s): �M
Owner Mailing Address: .5�—
Deser' tion of Work Proposed
n l. C' Please t��e or plirit clearly:Altacli addilioj2al sheets, as necessary
Name of App '
caner []Contractor ❑Tenant ❑Other:
Signature: �:� lu i�'�1a
Date:
Tel. I-re- d 'L 4e1. cov^
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:
a
ui
,h Q
. s t< ., -
o
ld
_
L ]fia I ul _
ki
o tX —
J0 m
u
- �' J - 2 - 0 1 is JNaay a 1 r � •
Ik it. LO p
fa Ig
Q27
gv So/_x of v C
13 �� "
� r
b a�
� LO ' cr) E
0u) O
� CA01,- 0 O
� a C6 U
� Q M OO c) 07
m CV to N
0 0 00 `
L0000
(D
m 0LL V
0J
w
r U
N 0 C
W 0�
_ � '0
g o
'41 cc cc
Cl E w cc
= T CI W OU UO
Na �i�� +U
0
m �' e:Z)
L
zw CO
4� .5
U
Q v -
+�. _
[6 N
La
a m _
O O N I
¢ Ia I