HomeMy WebLinkAboutApplication for Certificate of AppropriatenessAPPLICATION FOR
CERTIFICATE
OF APPROPRIATENESS
ALTERATIONS, NEW CONSTRUCTION
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HISTORIC RESOURCE AE
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NAME
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PLANNING DEPARTMENT
HISTORIC PRESERVATION
HISTORIC DISTRICT NAME
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OWNER'S NAME
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OWNER'S ADDRESS, CITY, STATE, ZIP CODE
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APPLICANT/AUTHORIZED REPRESENTATIVE (NAME & TITLE)
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APPLICANT'S ADDRESS, CITY; STATE, ZIP CODE 2 2
APPLICANT'S RELATIONSHIP TO OWNER
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OWNER'S E-MAIL
APPLICANT'S DAYTIME PHONE NUMBER
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APPLICANT'S E-MAIL
BELOW PROVIDE A DETAILED DESCRIPTION OF PROJECT ATTACH SKETCHES AND/OR ILLUSTRATIONS ON ADDITIONAL PAGE(S)
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NOTE: A COMPLETE CHECKLIST AND INSTRUCTIONS FOR REQUIRED ATTACHMENTS ARE ON REVERSE SIDE
❑ OTHER MATERIALS SUBMITTED
OWNER ATTESTATION: Pnnt dorm and Sign Below
I CERTIFY TO THE BES QF-MKKNOWLEDGE THAT ALL INFORMATION PROVIDED IN THIS APPLICATION AND ATTACHMENTS ARE CORRECT
SIGNATURE OF PROPERTY OWN
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