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192 Federal St - application for Cof NA Date Stamp c C.... Salem Historical Commission 4M �;va5�i Tnr:>:grGr se.Fr,, ua .a-.+ =-, For Office Use Only 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 Certificate ofNon-Applicability as described below for: New Construction Moving El Reconstruction n Alteration Demolition Painting ❑ Sign [2 Other District: FiDerby Street Lafayette Street ®McIntire Ow'ashington Square Address of Property: 19.2 Name of Record Owner(s): ! ,.�'/Ctt)hrr //�i Owner Mailing Address: �9� , d� ec�/ �>! %! CkM /1 O/9 7(/ Description of Work Proposed Piease type orionnt dar/y.Attach addition'9 emYj asnacess3y. El `)pyQi9¢ Rlpa.Q ©f kce-r cvhtC-h is 4akl/7� a/ -e A e 4r216C, 6oX i✓I ,� I f�<1� �� . �Cfc2 �lC17 i5 ct c&c/< or -+"A20K pcth1, e Vlf 10 4-Xk4cli,,,v -61, adjolt) iA� p0ecit on ckkA Sld� 1 0-et '-c (aif s up �,eytP45[ d /j'Yllir�/ZlQ l��2 ,�RiQCzii� /5 � iQu dh6�2 /Q[�o�i.E1�j 4��ic'ar�i�� Name of�Applic nt: l �C' j � -)wner0('omractorQTenantD-)ther: Signature. Ap �� Dater Tel. #: �� Jr� J—y�� E-mail Address: Paw pp/�✓�l1f�y//�i/� C'Cs�f Certificate will be mailed to the owner unless otherwise indicated here: Certificate should be mailed to: Name Mailing address: City: State:_ Zip: