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Att. 6
RECEIVED
Step I
ADD 9 9,
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COMMUNITY DEV. DEPT.
INITIAL HISTORIC SCREENING REQUEST
ADDRESS: /57 GrANd 4- /5-6 - 16.2 Fb wk i w ' PG
APN: (306- 17-3 -Dot -000 CAJof 40· Naower) votZoA) 00
H·0(,1'IAN %(cd<)
OWNER: 72mAN u ijJ I'N JA"ockl-es, LLC
APPLICANT: KI Acer ASIA A
APPLICANT MAILING ADDRESS: 542 L (*1 60056, Ave
PG q 34'5-0
APPLICANT PHONE NUMBER: 83l -544-97·Il ar 644- /6>N
Theownerofthepropertylocated at AOVe- Aleresses
has requested to have an Initial Historic Screening prepared.
An Initial Histotic Screening is a preliminary step that may or may not rule out the need for a
Phase 1 Historic 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 their recommendation to the Chief Planner as to
whether a Phase 1 Historic Assessment should be prepared. The Chief Planner will then either 1.)
Issue a Final Notice of Ineligibility, or 2.) Make a determination that a Phase 1 Historic
Assessment is required.
If a Preliminary Determination of Ineligibility cannot be made, a Phase 1 Historic Assessment
will automatically be required.
The Chief Planner has final authority as to whether or not a Phase I Historic Assessment will be
required.
/7- 2 _, 01'; · 4 -2-6-1 7-_
Owner/Applicant Date
Submittal Requirements:
1. Signed and dated Initial Historic Screening Bequest form
2. Proofofage of structure -•Adgt MCA- \N
Theownerofthepropertylocated at AOVe- Aleresses
has requested to have an Initial Historic Screening prepared.
An Initial Histotic Screening is a preliminary step that may or may not rule out the need for a
Phase 1 Historic 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 their recommendation to the Chief Planner as to
whether a Phase 1 Historic Assessment should be prepared. The Chief Planner will then either 1.)
Issue a Final Notice of Ineligibility, or 2.) Make a determination that a Phase 1 Historic
Assessment is required.
If a Preliminary Determination of Ineligibility cannot be made, a Phase 1 Historic Assessment
will automatically be required.
The Chief Planner has final authority as to whether or not a Phase I Historic Assessment will be
required.
/7- 2 _, 01'; · 4 -2-6-1 7-_
Owner/Applicant Date
Submittal Requirements:
1. Signed and dated Initial Historic Screening Bequest form
2. Proofofage of structure -•Adgt MCA- \
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