Agenda Item 6c Application# \;:)~ 0 \1 °\ Date received: 'o {q \ \-z,. $294 INITIAL HISTORIC SCREENING REQUEST PROPERTY ADDRESS: 'ziTh /v\Ayl.-i:- f!.it#: :[(. APN: _ _,e;c,_c_,_::Lc_··-_,1,,,"- ..--'-3__,i'--·..:..o...::·z..----'-1_ _ _ _ _ _ _ _ _ _ _ _ _ _ __ OWNER: 0-r-t,,Jt;0 S~ APPLICANT: J'.4,-J,~ !+JlcrJMI/- 1 \..\A:N'vHU~ e,o,0~-n'J(/Cf\O,,J APPLICANT ADDRESS: \\,;>&'). \ J: kA-uC,IS R-() 1 ~A1..--il\/A-S1 i,4· C:f3'10'] APPLICANT EMAIL: cl('...hiUVL,1'1/l-UV i_~ o.._C /. Q, oYV\ The owner ofthe property located at _'is",,._%_._·_,.· ,__,(-'--'-Y\Prtl~""i.A:"'-"'------------ has requested to have an Initial Historic Screening prepared. An Initial Historic Screening is a preliminary step that may or may not rule out the need for a Phase 1Historic Assessment. If the property is considered to be ineligible for listing on the City's Historic Resources Inventory (HRI), a Preliminary Determination of Ineligibility will be prepared by the Historic Resources Committee (HRC). The HRC will forward its recommendation to the Chief Planner as to whether a Phase 1 Historic Assessment should be prepared. The ChiefPlanner will either 1) issue a Final Notice ofIneligibility, or 2) determine that a Phase 1 Historic Assessment is required. The Chief Planner has final authority as to whether or not a Phase 1 Historic Assessment will be required. CERTIFICATION: I, the undersigned, under penalty of perjury, depose and say that I am the applicant for this request, that the owner of the property ,: v ofthis request, and that all statements are true and correct. ~· 7 31 12- Date Submittal Requirements: 1. Signed and dated Initial Historic Screening Request Form 2. Proof of age of structure 3. Copies of any original information pertaining to the subject property (original plans, photographs, original deed, name of original owner, name of original builder, etc.). Any information or documentation that you can supply will help minimize processing time. PLEASE NOTE: !fan Initial Historic Screening request is made on or before the 15th ofthe month, the Preliminary Determination of Ineligibility will be placed on the following month's HRC meeting agenda. The HRC meets .9,i tlit1'.i"' Weruie~day1 &'). \ J: kA-uC,IS R-() 1 ~A1..--il\/A-S1 i,4· C:f3'10'] APPLICANT EMAIL: cl('...hiUVL,1'1/l-UV i_~ o.._C /. Q, oYV\ The owner ofthe property located at _'is",,._%_._·_,.· ,__,(-'--'-Y\Prtl~""i.A:"'-"'------------ has requested to have an Initial Historic Screening prepared. An Initial Historic Screening is a preliminary step that may or may not rule out the need for a Phase 1Historic Assessment. If the property is considered to be ineligible for listing on the City's Historic Resources Inventory (HRI), a Preliminary Determination of Ineligibility will be prepared by the Historic Resources Committee (HRC). The HRC will forward its recommendation to the Chief Planner as to whether a Phase 1 Historic Assessment should be prepared. The ChiefPlanner will either 1) issue a Final Notice ofIneligibility, or 2) determine that a Phase 1 Historic Assessment is required. The Chief Planner has final authority as to whether or not a Phase 1 Historic Assessment will be required. CERTIFICATION: I, the undersigned, under penalty of perjury, depose and say that I am the applicant for this request, that the owner of the property ,: v ofthis request, and that all statements are true and correct. ~· 7 31 12- Date Submittal Requirements: 1. Signed and dated Initial Historic Screening Request Form 2. Proof of age of structure 3. Copies of any original information pertaining to the subject property (original plans, photographs, original deed, name of original owner, name of original builder, etc.). Any information or documentation that you can supply will help minimize processing time. PLEASE NOTE: !fan Initial Historic Screening request is made on or before the 15th ofthe month, the Preliminary Determination of Ineligibility will be placed on the following month's HRC meeting agenda. The HRC meets .9,i tlit1'.i"' Weruie~day1