Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
C of NA application for 3 Federal Court for fence columns
Date Stamp NOV 2016ILANNING IT [)E T- O Y DEVELOPM-hl = - COMM 57&em Historical Commission 120 WASHINGTON STREET.SALEM,MASSACHUSETTS 01970 For Office Use Only (978)619-5685 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 as described below for: New Construction [] Moving Reconstruction Alteration Demolition [] Painting Sign [] Other District: Derby Street []Lafayette Street TIMcIntire Washington Square Address of Property: 3 65k rQ -�- Name of Record Owner(s): ► I C a"d Name V 15 ph Owner Mailing Address: 3 Description of Work Proposed Please type orpnnt clearly.Attach ad&dcmal.sheets; as neeessalye 7 colow / ma �-�r; a 15 CI�J� �'1 a he6 C1 D�QY, X l S�7` O Lv CAS Sk,o c v ' Name of App ' nt: <<- 01S°K �erOContractor[]Tenant[]Other: Signature: Date: //l w�zol6 Tel. #: 7' ! 302 5� E-mail Address: (P C •6 - ©15o M @ comes 5 l I . r Certificate will be mailed to the owner unless otherwise indicated here: Certificate should be mailed to: Name Mailing address: City: State:_Zip: OF I r "�oil. 1 f 4 _Y. Il' i� _