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APPLICATION FOR A HISTORIC DISTRICT <br /> "CERT(FiCATE OF APPROPRIATENESS" � <br /> , <br /> ey sta�:Application#�P 1-� ��?�, Corrtributing:�Yes No Date Submitted.• �' �/o� <br /> '` - (Applican�Please prnvide information beiween the double lines) <br /> � C 6 Property Address or Location: _�.�„? � ,k f�1 S � <br /> Owne�'s Name: _ ��'l a r �l e Y r��- Phone:�/3,) Jf� ? --%B�� <br /> Appltcant's Name&Company(ifdifferent): <br /> ApplicanYs Mailing Address:_�jrv2g �,� sf <br /> App. Contact Info: Phone: Fax� Email: <br /> Type of Prope�ty: Residential,� Commercial Public or Other <br /> PROPOSED RESTORATION/�ENOfVAT10NS 1 REPAIRS ELOCATI N/ETC: <br /> Extea�ior Walls � Si9�� <br /> Exterior poors . ���9 <br /> Wlndows New Main Building or Addition to F�dsting Building <br /> Porches �j_New Accessory gldg,(9ara9e.ca. <br /> Awnings or Canopies N�d� � rport,shed) <br /> Fendng � P�P�1o,etc. <br /> E�derior Pairiting&Color Changes Buildjng,Demotition o�Relacation <br /> � Roofin Generai Repairs(describe below) <br /> g Other(describe below) <br /> Detailed descriptton of proposed wo�lc: (attach other shests if necessary) <br /> The Historic Preservation Board requires that the foibwing iMormation MUST be included with an application prior tio the <br /> application being accepted by staff; � <br /> • Detailed Pians.tncludJng a site nlan and elevation(sl: <br /> • S�olo�and material samoies; <br /> � 11�nufacturers sales Nterature• <br /> • Photoaranhsiand <br /> • My other suo�or�na documentation to show that the proposed woric is consistent with the adopted Departrnent <br /> erior tan . <br /> NATURE OF THE O and/or - � �cl''r `�� ��C.�� <br /> APPLICANT <br /> A icaM do NOT write BELOW fhis line <br /> ACTiON TAKEN: Date: <br /> ❑8y Staff: Approved Denied Reason for Deniai: <br /> �By HPB: Approved ✓ Approved with modfications noted below"and/or on attached sheets <br /> Denied <br /> `HPB Condition(s)of Approvai: )�/� e, <br /> Signed:! Ti`�c��! 5 �i�V.Q i� ' <br /> Date:�//�f j�, <br />