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APPLICATION FOR CERTIFICATE OF APPROPRIATENESS ALTERATIONS, NEW CONSTRUCTION CITY OF MIAMI HISTORIC ANO ENVIRONMENTAL PRESERVATION BOAR© NAME OF HISTORIC SITE OR HISTORIC DISTRICT re) E ADORES OF PROPERTY t N,-�S % � 6 o O'.'JNER NAME OWNERS EPHONE NUMBER (DAYTIME) OWNER'S ADDRESS, CITY, ZIP CODE APPLICANT'S NAME (IF NOT OWNER) AP L1CANT'S TELEPHONE NU ER (DAYTIME) APPLICANT'S ADDRESS. CITY. ZIP CODE APPLICANT'S RELATIONSHIP TO OWNER DETAILED DESCRIPTION OF PROJECT (USE ADDITIONAL PAGE IF NECESSARY) ATTACHMENTS SUBMITTED WITH APPLICATION - • PLANS OF PROPOSED PROJECT [ PHOTOGRAPHS OF PROPERTY ❑ MATERIAL SAMPLES ❑ OTHER I CERTIFY TO THE BEST OF MY KNOWLEDGE THAT ALL INFORMATION IN THIS APPLICATION AND ITS ATTACHMENTS IS CORRECT. SI,G)NATUREP WNER DATE V SIG,NA.TOR OF APP .1C (IF OTHER THAN OWNER) E DAIS FOR STAFF USE ONLY: APPLICATION NO ❑i STANDARD CA SPECIAL CA ❑ APPROVED ❑ APPROVED WITH CONDITIONS 0 DENIED DATE RECEIVED DATE V. OF FINAL A ON resmor,f4t4301%. IlailVrgiltValeo*** 1)A1F,1637-0-„4.4c- , "."1"