Laserfiche WebLink
__—_— _—__—_--- _.__— _ _ ___. .__ _ <br /> � a� • <br /> � f� APPlICATi+�3N F�R A NtST+I3RiC DI�TRICT <br /> ' • `°CERTIFICATE �F APPRCyPRlATENESS" � � ._ <br /> . <br /> � ey sta�:Applfcation#.t�s PA�_� % Corrtrib�ng: Yes/No Date Submiffed:� �1.5 � <br /> � _ (Applican�Please prz�vid'e Information beiween the dnuble lines) <br /> . � , (� • .._ 9� <br /> � C p Proper#y Address or Location: ��2 "`�l' � �'�h �,2�'��_ ���'`���N'"G��� 'F'�����`�'� <br /> Owner's Name: (�,/��G�� d'� � �t�� � l, �.C',Phone: �l���d�J�'7 <br /> � Applicant's Name&Company(ifd�tfererrt): G`�i.t�JA.1�/'�' ��� <br /> APpiicanf s Mailing Address; �`��� �� ��" �, f�i.�l�i1�s �:� ��sr�� <br /> I <br /> APP.�%oritact lnfo: Phone:��,� � "'Z��---�' Fa�c: - Ema3t: <br /> T e of��Pro . Residesi#iat Ca�rne�at � Pu6tic as O#her <br /> YP R�Ir' � <br /> . . . � <br /> PROPQSEO RESTORA7'ION/RENOVATIONS/REPAIRS!RELOCATION/ETC: <br /> � <br /> ���Eacteriot�Ualis � �c9�D � Sigr�age <br /> Eatterior C!c rs � U9M�9 <br /> • ����Wlndows /�`j �j/(p.�("G U✓i�'�/' � '' New MaPn Building o Addition t�Exisfing Buitdmg ��A ���� <br /> �Porr.hes � �1/�r•J L/�=��l,J'} �_New Acc;essory.8ldg. garage�carport,shed �.P.l�- �3 i3 <br /> � Awnings or Canapies I New dedc.ramp.patIo,e�c.i.c�t����r���'-�-��R.L�, � <br /> �""'��t�l� F„�� '�r;Building.Demolr�on or Relacatiion ,�f�f,s/.�-��f <br /> or Pai�ng&Cator°C�hatiges I General R�airs(de��crbe below} <br /> � ne a <br /> ��FG¢f� ,�a{�g � . L,,._Other(descdbe below) , <br /> Defiar7ed descr�p�on af propas,d work�•(attadz other s�eets if neces�ary} ���-�f l C/ri� ��� <br /> ..p � <br /> ..._ � , - <br /> . _ _,._ : ____.=t.._.-�-- <br /> The His#oric Preservatio�8oard requires that the foUo�ng irdormation MUST be included+with an applica�on prior to the � <br /> applfcafian being accepted by s� <br /> . • Detailed Ptans.induding a site alan and elevation s• <br /> . Calar and material sam�les: <br /> . �Illanufactcuer's sates 1'derature: <br /> . Phatoctraohs:and <br /> • JMy other supportina docs�rnentatfan ta show a#the propQSed work#s consistent wittrthe adopted Depa�#rnent <br /> of irrterior Standards. � <br /> <. f _ � � 1�.�A�-.�7 ���jJ� ��",� .�,� <br /> SiG TURE OP THE OWN aridla� � APPLlCANT <br /> ' (A liraarrt do NO� write BELOW#ris Grre) � <br /> AGTtON TAKEN: Oa#e: �� 2-� � . <br /> QBy S#�fF. Approved Denied Reason for Denia3: <br /> 8y HPB: Approved °' Approved with m dfications noted betow*anrtlor on attached shee#s <br /> Denied ���l � �1(�.�1't,� �t?1�� 11'1GI� '�,�'�!5�1'Y14� ��'YU'(�� . <br /> . <br /> 'HPB Gondition(s)of Approvai: � w ti ��` <br /> � � � � �� ��,ed. � �.�s� 11'� r e.�, <br /> � . , <br /> Signed• Date: I J <br />