Application for inkind roof - 17 Warren Street " kT RECEIVED
y{.
OCT 14 2016
DEPT. OF PLANNING&
Salem Historical Commission COMMUNITY DEVELOPMENT
120 WASHINGTON STREET SALEM.MASSACHUSETTS 01970
978)619-5685 FAX f978E 740-Du04
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 a Certificate of Non-Applicability as described below for:
❑ New Construction ❑ Moving ❑ Reconstruction ❑ Alteration
❑ Demolition ❑ Painting ❑ Sign ❑ Other
District: ❑Derby Street El Lafayette Street blclntire ❑Washington Square
Address of Property: I kle-r ehi, S 4W_I.
Name of Record Owner(s): 2 ,,�f 11 : �C�C fjvl
Owner Mailing Address: !jL.rKe_ --
Description of Work Description of Work Proposed:
rD0 a C - �-e_ mA avl llipC�
Applications must include photos of existing conditions, taken from all public ways,
Name of Applicant: J
- zzc, Sc
pp � 0 Owner ❑Contractor []Tenant ❑Other:
Tel.#: 6-799 getl —0-s_/ E-mail Address:�aC�.��65���� L•k10'_MG,4' , C
Certificate will be mailed to the owner unless oth rru ise.indicate here
Certificate should be mailed to: Name I �� � /�_ JG �I
Mailing address: f 0 ri"P .S h` City: Sic(e4+, Statp4-Zip: L