10 Summer Street CofNA applicationDate Stamp
For Oflice Use Only
ntr
Address ofProperty: /b -(a,,,,,..r r
trn
New Construction
Demolitior
! Moving
@ - Painting
Reconstuction
Sign
Altelation
Other
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,
applicatior is hereby made for issuance ofa Certificate ofNon-Applicability as descdbed below for:
ntr
District:nDerby Steet Elafayette Street llMclntire lWashington Square
Name ofRecord Owner (s):
Owner Mailing Address:
r,, rl. /J,,,,. cir
Description of Work Proposed
I'leasc t]?e or print clearly. Attach addition:rl shccls, as ucccssiuy.
\fL
i;L\1..r,.,)
t':)
Narne of Applicant:t p,,,ffiwner f ]Contactorfl Tenant [other:
Datet '+1i,1 llLf,.i.4tl