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� APPLlCATION FOR A HISTORIC DISTRICT <br /> "CERTIFiCATE OF APPROPRIATENESS" � <br /> ey stat�•Application#. Corrtributing:�'�e' /No Date Submitfed.• � i� f <br /> � . (Applicar�Please prdvide information betwsen fhe doub/e lines) <br /> . <br /> � C�Property Address or Location: �� � � �� ��° • � ���1� <br /> Ovmer'sName: t !�'�.:5�� ..�[/v;tii���� Phone:,�S'SL� �-��-��i%f.i <br /> AppiicanYs Name&Company(ifd�er+ent): <br /> ApplicanYs Mailing Address: ��f� ����`–�' �£'���-i.�.�G��r �LS� � ���ll� <br /> App. Contact info: Phone:�'%i �!� �� Fax: � Emaii• <br /> . 7-Zti�i'��;r��`-�t�•t,�il-ei:����'i�'� <br /> _�--.-- <br /> Type of Property: Residential Commercial ✓ Public or O�Cier <br /> PROPOSED RESTORATION/RENOVATIONS/REPAIRS 1 RELOCATION/ETC: <br /> Exterior WaAs � Si9na9e <br /> Exterior poors • Ughting <br /> _�Windows . New Main Building or Addition to Existing Buiidtng <br /> Por�ches New Accessory.Bidg.(garage,carpo�t,sfied) <br /> Awnings or Canopies New deck,ramp,patio.etc. <br /> Fencing Building,Oemolition or Relocation <br /> Exterior PaiMing&Cobr Char�ges General Repairs(describe beiow) <br /> - ` Roofing Other(describe below) <br /> Detailed description o proposed ric: (attach other sheets if necessary) �"� � �,�i,r���,�j t�:�» C!�U,j _ <br /> � � <br /> - — - -. .. . <br /> The Historic Preservation Board requines that the fodowing information MUST be inciuded with an application prior ta the � <br /> application being accepted by sta[f: <br /> • Detailed Plans.induding a site nlan and elevation(s): <br /> . Color and material samoles: <br /> • Manufadurer's sales literature: <br /> • �hotoaraohs:and <br /> • My other suonortina documentation to show that the proposed work is consistent with the adopted Departmerrt <br /> of Mterio�Standards. <br /> ..- � _ _��k�:r�5� _�;�"ti i�tn c��� <br /> SiG TURE OF THE OWNER and/or APPLICANT <br /> � (Applicarrt do NOT write BQOW this line) <br /> ACTION TAKEN: Date: tVf�,i'<��i /��� � ��'� <br /> �y Staff: Approved � Denied Reason for Denial: <br /> (�rBy HPB: Approved � Approved with modfications noted below'and/or on attached sheets <br /> Denied <br /> `HPB Condition(s)of Approvai: 9�I�I ) �. <br /> „ � . <br /> Signed: �' � /� ,/.,.-- Date: ,� I� - �. � I �— <br /> , <br /> ; <br />