HomeMy WebLinkAboutCOA ApplicationLittle Rock
HISTORIC
DISTRICT
COMMISSION
City of Little Rock
Department of Planning and Development
723 West Markham Street
Little Rock, Arkansas 72201-1334
'LIM Phone (501) 371-4790 Fax: (501) 371-4546
www.littlerock gov
N APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
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N
960 Address of Property:
N
Z Legal Description of Property: _
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STREET ADDRESS:
Owner/A ent (Printed Name):
Owner /Agent Street, City, State, & Zip: :{
Owner/Agent Phone Number:_,_!
Owner /Agent Email''
Name of Applicant as it will appear on all correspondence and in Staff report:
Brief Project Description:
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Estimated Cost of Improvements:
Zoning Classification: Is the proposed
Signature of Owner or Agent:
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permitted Use ;"Yes c No
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NOTE: Should there be changes during construction (design, materials, size, etc.) from the approved COA,
applicant shall notify Commission staff and take appropriate actions. Approval by the Commission does not
excuse applicant or property from compliance with other applicable codes, ordinances or policies of the city
unless stated by the Commission or staff. Responsibility for identifying such codes, ordinances, or policies rests
with the applicant, owner, or agent.
DO NOT FILL IN - FOR STAFF USE ONLY
Application Date: HDC File #i
HISTORIC DISTRICT COMMISSION DOCKETED at 4:00 p.m_
LITTLE ROCK HISTORIC DISTRICT COMMISSION ACTION:
DENIED _ WITHDRAWN APPROVED APPROVED WITH CONDITIONS SEE ATTACHED CONDITIONS
DOCUMENTING OFFICIAL SIGNATURE: DATE:
Historic District.dccx Page 3 of 5
revised 5/8/2020
City of Little Rock
Department of Planning and Development
723 West Markham Street
Little Rock, Arkansas 72201-1334
Phone (501)371-4790 Fax: (501) 371-4546
www littlerock.gov
CERTIFICATE OF APPROPRIATENESS AUTHORIZATION OF REPRESENTATION AFFIDAVIT
!, ✓s 's = r'' ' ' l=. ? fsr , •" do hereby authorize
r
Property owner (print)
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F' ° } •` ' F to represent me and my interests in an
Agent/representative name and business (print)
Application for a Certificate of Appropriateness on the following property described below. I have reviewed the
proposed application and I have indicated so by initialing a copy of the submittals that are attached.
Street Addrass r rN'-'.1' "% Z;,
Title Holders Signature
Agent's Signature
Date
Date
Subscribed and sworn to me, a Notary Public on this day of
Notary Public
My Commission Expires:
Historic District.decx Page 5 of 5 revised 5/8/2020