16 River St - Cof NA application 0
RECEIVE ®
Ij2� n,�l 1n�r DEPT. OF PLANNING &
Comty UNITY DEVELOPMENT
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MA 01970
(978)745-9595 EXT. 311 FAX(978)740-0404
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 for:
Construction Moving Reconstruction Alteration
Demolition �iht Sign (Other
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as described,/I^ nbelow. I
District: /I +^t v-e Original Building Construction Date, if known: Na
Address of Property: h e( Ui_e� 4+_
Name of Record Owner(s): Kev WA Z `v 1etccl,R Ma yl ke4Lts
Description of Work Proposed:
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Signature of Owner: 1 ,�• eY `7L/ r Tel. 4: �J��• % l2' � �0
Mailing address: I J V City:_ State:A4A-Zip: Q�
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