18 Washington Square West �WRE
G C 3 i 2015
Salem Histojzcal Commission CC:
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01970 For Office Use Only
(978)619-5685 FAX(978)740-0404
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
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 Appropriateness for: /
❑ New Construction ❑ Moving 0 Reconstruction B Alteration
❑ Demolition ❑ Painting ❑ Sign ❑/ Other
District: ❑Derby Street ❑Lafa ette Street I ❑Mchitire N1Washington Square
Address of Property: (� �Z ,�ti 7
Name of Record Owner(s):
Owner Mailing Address: '7 l?ve
Description of Work Proposed
� II Please tJq.)e or prml l cle/a�rl}: Attwb additional steers, as necessaq: A,, ,A Tkt fW P,754j Stare s J wq ok '�I.1/ /19 �JL.✓AAA.-545N S't, �Q SAG I1_`77 1 t"'wln.TfT.t LR�}�Al
�T 4 (-el"(1t ,,-1 1� dx%�� V-5 L4L 003 tx"� 64 1'foo.NJ NLb`dt/o--s w LIL, C,
StLS1L (thlvkt. 2t! 1Co v6lo AL z ) 11
APe fZ« eL LQFF s:cfc �b Iti. 6 ;I�tVI 'I. Cck a,A_ 114 'laC "(t t"-JAM wL�o p
s,,4 C$ 'ham b.,IU
Name of Applicant: ❑Owner ❑Contractor ❑Tenant ❑Other:
Signature: Date:
Tel. #:_ �8- SO y —OD t f; E-mail Address: 4 rel V,s . S- 011 1 (5-?6 wu,d- U •v�
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip:
b � n� ` ,
{q.'; �'
S 'F'-
J
1 .
J..:, 1+.
( � � F��� -
Y Xy, ���
�.F�Yt _+'�`� � � ��
/1 �)
a. � �, [
��'.0 � L
`a ?.
Z
wQ
f' S
r�#j^�J`iP�, 'J 3... �1.'
F ? � {
ryy {
e
9 titer s y
�� K�..
y$
�`�p„" .�. f� 5
y # �,.
` 1
y �,, ' � �
3
� ���.�
a _� .�
w t
t .
_,_� � � �'
-- � '
r:
:; � - r �
� � �� � � � 3
�iii
n
7 " ��
� �� � Y- �
� �..
�•� ��r�7 .,, ,:
+�"� � 4 � a
{_,
�.._
:.
,
,
i
2 _
� � I
F � ear
Amu
23
ofwl
Tj
Lot -V
_ � t
LoI 1
_131
c 61
X 7 ♦ i
I
s
t C €
xx> k
F
4
� s
F
YF�}
!AX
p�Qr
Ci
3 yy'
Y
5 l�
i
4 - '
.j rye. .. i� Y4Y +'IS. j 9e..M6if 4 4X C 5 .F ♦� R
Y
i :x�
}.. ♦ wa,, f_ , <[� � t � � :'h, : �"s'°. c :fie �-•
s t
� � I
�u
6
Mal
r iZ i r .4 A E c'm+! t 'gHYnpw
} { 7
LJ
!.`4
a
- Lin S.
i (
IV
a �=
r
• y � 6 x � a S 4 e
i 2 �
4 t Y
iii $ 4
y Sf •
a 1 .::aRt •.� 6 p � f... -. '�ez;.W .. 9^r v+
i E S
•