266 Lafayette St - C of A application for gutters Date Stamp
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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 [ afaye#te Street ❑McIntire ❑Washington S wre
Address of Property:
Name of Record Owner(s): Wc�/�et
Owner Mailing Address:
Description of Work Proposed
Please type orprmt clearly.Attach additional sheets, as necessary.
Name of Applicant: e/V a 2(5»ner❑Contractor❑Tenant❑Other:
Signature: — — , Date: ll Z
Tel. #: 1 'ey6 't`�� E-mail Address: Qy r �k � �•��1.
Certificate will be mailed to the owner unless otherwise i ted here
Certificate should be mailed to: Name �P�J I'P t Alf
Mailing address: z66 �,�y�7r Citv:owwt State Zip: t