329 Essex Street application RECEIVED
`�-- FEB 2 2 2016
Salem Historical CommissiOAPT. OF PLANNING &
120 WASHINGTON STREET SALEM.MASSACHUSFTTS01970 COMMUNITY DEVELOPMENT
978j 619.5685 FAX 19?8)74r.040- - /D., pr rj O PP-L .a--TIL
APPLICATION FOR A CERTIFICATE OF NOz LICABILITY ul s I B IL, _
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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 9"" Other
District: ❑Derby Street []Lafayette Street �Iclntirre� []Washington Square
Address of Property: 3-Nq "ZSSEX/� 1 �10.`e t' i I d k21 '70
Name of Record Owner(s): 1
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Owner Mailing Address: l 1J1�`t0.r�5 0.� I " 1 -' 6\(zk�76
Description of Work Proposed:
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Name of Applicant: Q (\ 0�0. �� �� hJOwner ❑Contractor []Tenant ❑Other:
-n-l Address:
Certificate will he mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip: