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, d�i���������� ���� ������� ��m����� , <br /> 66�foE����E�+d°�H� �8' b'9���4����i`�116�D'�6���99 •- . <br /> �y sta�t A�p1lca�on�. � 8�,� Corrtrrbce�ing: +es/f�c� Daf�Submat�edo�.�,���.�� . <br /> . �r � <br /> -. _ {Apprcan�P/ease pmvide infomration between the double/ines) ��� ,� <br /> @ � '7��'� � <br /> � ���r�operty Addr���or L�ca#ion: �i'7 ��/ l�� S�', � /� �-� �� <br /> ,� f'1 rl PhO�e �� '�/�� ���C�r`t���'�� <br /> Ouime�s IVarn�' � � <br /> �lpPlic�nf s�tam���ompany(ifd'rf�erent}: -- <br /> APplican#'s�a�ling Address: ����- L�}�r� , Z���GI��C'.�o C�-S �"G 3..�.S� <br /> �'�3.,7 i� �GC.��-_ L, l;G'�l� <br /> ApP.C�anfiact tnf�: Pha��:8���l�-2~ ��3�- �c: Esrtait: ��J�SS�i+�D '7�F�� <br /> � • • <br /> Type of�iatoperty; R�sider�tiai Comm�e�ia! �ut�lic or�fher <br /> PROPOSED RES'POF�TId�N/REl190V1'/ATIONS i REP�►IRS/RELO�ATION I E'�C: <br /> F�de�iorWalts� � 5�9�9e� <br /> i F�erior C?oars � �9�9 . <br /> � Windows . hiew Main 8uitdr�g orAdcliifion to E�6sting 8uiiding <br /> pa� New Accessory.Bidg:(garage,carpor#,shed) <br /> Awnings ot Canopies Nev�r deck,ramP:i��,e#c. , <br /> p��g Buitding,Demolition or Reloca�an <br /> . E�derior Pain6ag�Cator Chae�ges Genera!Repairs{desr.r�e belaw} <br /> �- �Raofing � • �Other{describe aetow) . <br /> Deta�'ted criptio ,af p pase��•{ dz ofher stie a��ecessary} _.f� � <br /> � The Hist�ric Freservatio�Boacd requires that the fod�wing information MUST be included witi7 an application priot to the � <br /> i aPpiication being accepted by staif: <br /> ; • Det�'ted Plans.including a 'e lan and elevatian(sl: ' <br /> � Cola�and material sam�: <br /> o anufacture�'s saies literature: <br /> ; . Fhataaraohs:and <br /> o Any ather su000r�na dor.urt�eritafian tn show fhat the propased wark ts consistent wifh�the adopted Dep�artrnerzt <br /> af Interior Standards. <br /> ;�^��.. <br /> � Si NATURE O E OWNER and/or � , APPLICANT <br /> � /Ap�licataf da Nr3T vvrfte BEG4W fhls�ine) <br /> i ��. � <br /> � AGT10N TA1i�N: Date: �`3 f • 24 t� <br /> j � <br /> i ❑8y S#aff: Apgrovec! Qer�ied #�eason for Deniat: <br /> � - � <br /> ' QBy HPB: A�proved � ApProved w�h madifit�#ians nateci befaw*andlor an affached shee#s <br /> Deaied <br /> 'HPB Condition(s)af Approvai: <br /> �` ��.._.. _ Date: � -�/-,.�6 !� <br /> Signed• � <br />