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qppLICATION FOR A HISTORIC DISTRICT . <br /> � "CERTIFiCATE OF APPROPRIATENESS" _ <br /> ey stat�Application#. l°Al� ����S� ��b�9� Yes' o Dafe Submitted: �- <br /> ^ , (APP���p�se p^�v�de l�orrr�atlon beiw+een fhe doub/e Grres) <br /> � C�Property Address or Location: j��fJ<� �k�, � _ <br /> Owner's Name: �f �c� ���", �� _ Phone: U�S-��~I-�3"3'7;� <br /> AppiicanYs Name�Company(lf d'�ler+en�: ��� ���r� "`� <br /> AppiicanYs Mailing Address: 5v'�'�' � - <br /> App.Contact Info: Phone: � � �' ���� <br /> Type of Property: Residerrtiai_� Commerc�al Public or Other <br /> PROPOSED RESTORATION/RENOVATIONS!REPAiRS 1 RELOCATION!ETC: <br /> Fxberior Walls � S�a9e <br /> �� . New�Matn Buiiding or Addidon b E�asti�9�9 <br /> p�s New A�esscry Bldg.(garage,carport.shed) <br /> Awnings or Canopies New deck.rarr�p.pa�o,etc. <br /> F�� Building�DertwNtlon or Relocation <br /> E�derior Pairrting&C�Obr Changes Get�ai Repairs(desa�be below) <br /> ��oo�u,g (rn e ta/� Other(descxibe below) <br /> Detai7ed descriptlon of proposed work: (attach otl�er sheets if necessary) <br /> The Historic Praservation Board requires that the fodowing ir�formation MUST be induded with an application prior t�the <br /> applic�On being a�ePted bY s�f: <br /> . Detatled Plans.indudin9 a site°lan and elevation(sl: <br /> . c`��and material samole.s• <br /> • lutanufachuers sales IiEeretute' <br /> • PhofiDOraDhs:and <br /> • My other Q��!�rtina documentation to show that the proposed wo�ic is consistent with the adoptied Departmerrt <br /> of tnterior Standands. <br /> S1G TURE OF THE OWNER and/or �PU�T <br /> (Applfcanf do NOT wrrte BELOW thls�ine) <br /> CTION EN: Date: <br /> y Staff: Approved Denied Reason for Denial: <br /> ❑By HPB: Approved Approved with modifications noted below`and/or on attached sheets <br /> Denied <br /> 'HPB Condition(s)of Approvai: <br /> Signed: Date: <br /> � �� <br />