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' - � I HISTORIC DISTRICT <br /> APPLICATIO FOR A , <br /> "CERTIFiCA E OF APPROPRIATENESS" � ._ . <br /> ey stat�Application#. _ C rrtrib�ng: Yes/No Dafe Submitted.• <br /> � ,, (Applican�PJease mvide iriformation beiween the doub/e lines) <br /> � C�Property Address or Location: <br /> Owne�'s Name: � � �► Phone: ��(' 3"77�7=��b .� <br /> ' � <br /> Appiicant's Name&Company('�f differ+ent): , � <br /> ApplicanYs Mailing�+ddress: L. <br /> App. Contact tnfa: Phone: 3- = � �Fax: • Emait: <br /> Type-of Property: Residential�_ Com i ercial public or Other <br /> PROPOSED RESTORATION/RENOVAT ONS/REPAIRS/EtELOCATION/ETC: <br /> 6derior Vlfalis� � 5�9�9e <br /> Exterior poors . I Lighting <br /> Wtndows . I New Main Buiiding or Addition t�E�dsting Buildng ' <br /> po�eS I New Accessory.Bldg.(garage.carport,shed) <br /> Awnings or Canopies I New deck,ramp,patio,etc. <br /> �Fenang �('��lQC2l'YI �YL�� I Building,DemolitionorRelocation <br /> Exterior Pa�nbng&Color Changes I General Repairs(describe below) <br /> .- � �' R�{�g • . I Otfier(describe below) , <br /> D tailed description f proposed work: -(attach ther shegts ff necessary) �, e n <br /> � � � � � r <br /> , _� i . <br /> .. . --_ - � - - -- -� ���- � ------� -----.... . <br /> The Histnric Preservation Board requires that th odowinlg i rm on M ST be included with an application prior to the <br /> appiication being accepted by staff: <br /> • Detailed Plans.induding a site olan an elevabon(s1: <br /> . Color and material samales; <br /> • Manufacturers sales literature; <br /> �Photo4raohs•and � <br /> • Any other su� ortin documentation to show that the proposed work Is consistent with�the adopted Departrnent <br /> 1 rio tan s <br /> ~ �l/JL✓� ��`✓►1�e.�'f'�.� <br /> SiGNATURE OF i'HE OWNER and/or APPLlCANT <br /> � A licant o NOT wrife BQ.OW this rne <br /> ACTION TAKEN: Date: � c� O I I <br /> �By Staff: Approved� Denied ; Reason far Denial: <br /> � <br /> ❑By HPB: Approved Appraved ith mod'�ications noted below"andlar on attached sheets <br /> Denied <br /> `HPB Condition(s)of Approvai: <br /> ' Signed• Date: l �02 ��/.S <br /> i <br /> � <br /> i <br />