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„. ._ �C� S �J (., ,�x� <br /> , o��i m�- � ,� <br /> � � <br /> �� T�����1 <br /> � APPLICATION FOR A HISTORIC DISTRICT <br /> �� "CERTIFICATE OF APPROPRIATENESS” <br /> ay star�� Application # Contribufing: Yes / IVo Date S�rbmifted: �/��r <br /> (Applicant, P/ease provide information befween the doub/e lines) <br /> Property Address or Location: ��� 3 � t h � t <br /> Owner's Name: � ��o h / �' ` C � �'[ Phone: <br /> AppiicanYs Name 8� Company (if different): � � ° � a � � � �'"'`"�^ � ° a � tR '��" � �` � <br /> ApplicanYs Mailing Address: � � � ��` � � � � � " �` ��'^ +� `' � � 3 '��� � <br /> ApP.Contactinfo: Phone:��3'��O���S �3�d� <br /> Type of Property: Residential � Commercial Public or Other <br /> PROPOSED RESTORATION / RENOVATIONS ! REPAIRS 1 RELOCATION / ETC: <br /> Exterior Walls Signage <br /> Exterior poors Lighting <br /> Windows New Main Building or Addition to Existing Building <br /> Porches New Accessory Bidg. (garage, carport, shed) <br /> Awnings or Canopies New deck, ramp, p�tio, etc. <br /> Fencing Building, Demolition or Relocation • <br /> � Exterior Painting & Color Changes General Repairs (describe below) <br /> _ � Roofing Other'(describe below) <br /> Detailed description of proposed work: (attach other sheets ff necessary) o rvp ` �,� ci �� � T� <br /> G/k� '��rcri�.�e <br /> The Historic Preservation Board requires that the following information MUST be included with an application prior to the <br /> appiication being accepted by staff: <br /> . Detailed Plans, inGuding a site alan and elevation(s): <br /> . Color and materiai sam�les; <br /> . Manufacturers sales I'�terature; <br /> . Photoaraahs: and <br /> • Any other su000rtina documenta6on to show that the proposed work is consistent with the adopted Department <br /> of Interior Standards. <br /> s���`�" � ` � . ( � <br /> SIGHATURE �F THE �WNER an r• APPL ��� <br /> plicanf do NOT write BELOV v <br /> � /�, � <br /> ACTION TAKEN Date: ��� <br /> � C, � � �G:;s�%�x' `����` ` <br /> ❑By Staff: Approved Denied Reason for ( � <br /> �� ,��,�,�� , .a� � <br /> ❑ By HPB: Approved Approved with modifications nc ��� �� �� <br /> Denied �� <br /> � <br /> ) " HPB Condition(s) of Approval: �� �� � C— ��� <br /> ��� <br /> � <br /> Signed: <br />