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A�►PPLOCAYOON FOR e4 HISTORIC DISTR��T <br /> 6iCERTIF�CATE OF /�PPROPR9ATEIVESS99 <br /> . � <br /> • ey sta�•Application#.�� � �'� Corrtribu ing: es/No ,Date Submifted: <br /> --� _ (Applicant,Please provid�formation befween the double Irnes) <br /> � �p Property Address or Location. ��Qf)� ���� �� �1����1_��� �S �"C. `,�� � <br /> Owner's Name: �} I Phone: �S ��' Df� <br /> . I� _ „ �}.� <br /> Applicant's Name&Company(if different): ��P.�QU1 f�C Qd(YD.S C (�°_a <br /> ApplicanYs Mailing Address: <br /> App. Contact Info: Phone: � �-��/ F x: • -Email:� �r I _f'T�Y f C i�°�� <br /> t'al `� Commercial Pubiic or Other <br /> Type of Property: Residen i <br /> PROPOSED RESTOI�ATION/RENOVA'FIONS/REPAIRS/RELOCATION/ETG: <br /> Exterior Walls Signage - <br /> Exterior poors • I Lighting - <br /> Windows I . New Main Buiiding or Addition to Existing Building <br /> Porches New Accessory Bidg.(garage;carport,shed) <br /> Awnings or Canopies New deck,ramp,patio,etc. <br /> ��Fencing Building,Demolition or Relocation <br /> Exterior Painting&Color Changes General Repairs(describe below) <br /> Roofing I Other(describe below) <br /> Detailed d scription of ropose ork: (a c othe sheets if ecessary) <br /> I � � Cl1� �� <br /> The Historic P�eservation Board requires that the fotl Iwing information MUST be included with an application prior to the <br /> application being accepted by staff: <br /> • Detailed Plans,including a site lan and elevation(sl: <br /> • Color and material samples; <br /> � Manufacturer's sales literature; <br /> • Photoaraohs:and <br /> • Any other suadortina docum�entation to sho that the proposed work is consistent with the adopted Department <br /> of Interior Standar s. <br /> �/ / ! ��4 al1!� Q�f t7�1n/�/I CrT�-P <br /> ATUR F TH NER•and/or I AP LICA T � <br /> A licant do NOT write BELOW this line <br /> ACTION TAKEN: Date: I � I <br /> ❑By Staff: Approved Denied Reason for Deniai: <br /> �L/I By HPB: Approved " . Approved with I odifications noted below*and/or on attached sheets <br /> Denied I <br /> *HPB Condition(s)of Approval: ��� U ►� � <br /> - � �ra I 5 `� �(.+Ir'hClO)c) C(?�. <br /> Si ned: Date: � /� i J <br /> 9 <br /> I <br />