Laserfiche WebLink
� APPLICATION FOR A HISTORf C DISTRtCT <br /> "CERTIFICATE OF APPROPRIATENESS" � <br /> ey staf�Application#.k P� k L`� 9 Corrtributing: Ye /No Date Submitfed.• <br /> ^ s (APPri�ca�Plaese provlde lydqrrna�an beiween the dou�le Hrres) <br /> � C�Property Address or Location: ���'f � �� S'� . �z,�.�h�i r h( I S 'T {� ���1 <br /> Owne�s Name: 1�►�"'��f ' ' I R� l.�l� � ��itST��Phone: ��o�' '7� i'�5�� <br /> Appiicant's Name&Company(ifddler+e�: `�-t7 ► �� � <br /> ApplicanYs Mailing Address: <br /> APP. Corrtact Info: Phone: F�x: • Ema�• . <br /> Type of Property: Residential�_ Commercial Publlc or Other <br /> PROPOSEO RESTORATION/RENOVATIONS/REPAIRS/RELOCATION/ETC: <br /> E�derior-Walis � S�nage <br /> Exterior poors • V9�9 <br /> Wlndows . Wew Main Building or Addltion to 6dsting Buli�ng <br /> Porcftes New aa�rY BId9•(9ar�8.ca�pOrt.Shed) <br /> Awrtings or Canopies New deck,ramp,patlo,etc. <br /> Fendng 8uiidtng�Demoli�On or Reloca�on <br /> �Exterior Painting&Cobr Changes Ger�e�(�escribe below) <br /> �9 <br /> Detade descriptlon proposed w�ork:�tta eets if necessary) �+ <br /> , <br /> � '� <br /> The Historic Preservat�n Board requires that fhe fodowing intormation MUST be inchided with an appltcatlon p�to fhe <br /> aPPlication being axepted by s�if: <br /> • Dehailed P(ans,induding s site nian and elevatton(sl: <br /> . Color and material samoles: <br /> • ALI�nufad�u+ers sales literature: <br /> . Photoaraohs:and <br /> • My other�u000rtina documentation to show that the proposed w�oric Is consistent with the adopted Departrnent <br /> of h�terior Standar�ds. <br /> RAM i YU Cc� N T/'� ��► r <br /> SIGNATURE OF THE OWNER andJo� APPLICANT <br /> (Applfcaitf do NOT write BEI.OW thls Nire► <br /> ACTION TAKEN: Oate: <br /> �By StafF. Approved� Denied Reason for Denial: <br /> ❑By HPB: Approved Approved with modfications noted below•and/or on attached sheets <br /> Denied <br /> `HPB Condition(s)of Apprcvai: <br /> Signed: Date: <br />