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APPLICATION FOR A HISTORIC DISTRICT "CERTIFICATE OF APPROPRIATENESS" By staff: Application #. Contributing: Yes / No Date Submitted: (Applicant, Please provide information between the double lines) c ,: Property Address or Location: .1);2 / I;; 1 ~:s-t ~h 1" A A 1 ~ Pi LJ . ~ ,-/ ." 111 n ~D v-'~-a~' Owner's Name: ~-:.J; ~ i J'2J ... r :~. jiAtJ Phone: X'~~ - ~gd<?..o:J.1 Applicant's Name & Company (if different): ~;;t r l.eJy i 8~~ ,5x.c Applicant's Mailing Address~~*~~ ~ App. Contact Info: Phone: 13 -1 IS-lcJ ~lJ Fax: - Email: Type of Property: Residential Commercial Public or Other v PROPOSED RESTORATION I RENOVATIONS I REPAIRS I RELOCATION I ETC: Exterior Walls Exterior Doors Windows Porches == Awnings or Canopies _ Fencing _ Exterior Painting & Color Changes ~ Roofing _ Signage _ Ughting _ New Main Building or Addition to Existing Building _ New Accessory Bldg. (garage, carport, shed) _ New deck, ramp, patio, etc. _Building, Demolition or Relocation _ General Repairs (describe below) _ Other (describe below) .~ a ~.~. 'q~ The Historic Preservation Board requir~s that the allowing information ~ be included with an application prior to the application being accepted by staff: . Detailed Plans, including a site olan and elevation(s): . Color and material sam Dies; . Manufacturer's sales literature; . Photoaraohs: and . Any other suooortina documentation to show that the proposed work is consistent with the adopted Department of Interior Standards. siG~~~ c{t5:f:4Jor ~Ra.d APPLICANT , (Applicant do NOT write BELOW this line) ACTION TAKEN: Date: if ~ /2----f:J'-J...... D By Staff: Approved ~. Denied Reason for Denial: V' D By HPB: Approved _ Approved with modifications noted below. and/or on attached sheets Denied · HPB Condition(s) of Approval: ~ l hi- Date: Lf ~ I 2 ~rJ )..- Signed: