277 Lafayette St - C of A application - rear porch railings RECEIVE
s NOV 0 8 2017
Commission
DEPT. OF PLANNING &
Salem Historical (.�ommis, ion COMMUNITY DEVELOPMENT
120 WASHINGTON STREET.SALEM.MASSACHUSETTS 01970 L,5
(978)619-5685 FAX(978)740-0404 P-
D
APPLICATION FOR A CERTIFICATE OF NON-APPLIC ILITY li eoe,
Pursuant to the Historic District's Act (M.G.L. Chapter 40C and the Salem Historical Commission Ordinance p ) ,
application is hereby made for issuance of a Certificate of Non-Applicability as described below for:
0 New Construction ❑ Moving e Reconstruction ❑ Alteration
❑ Demolition ❑ Painting ❑ Sign ❑ Other
District: ❑Derby Street RLafayette Street ❑McIntire ❑Washington Square
Address of Property: L'7 A K.4 r -
Name of Record Owner(s): 4 o ]SX
Owner Mailing Address: -D K. tJ3 i Q �U qA V f
Description of Work Proposed:
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Applications must include photos of existing conditions, taken from all public ways.],
Name of Applicant: 7_4Cm GAV ❑Owner OContractor ❑Tenant ❑Other:
Tel. r 7, 5 qr},Z� 33 E-mail Address:
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name N L P�'V lZy 7. �s► C �
Mailing address: q.3 L 7(;S r,►!.o MA�: City: State:_Zip:
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