HomeMy WebLinkAboutHDC2011-0032 Certificate Of Appropriateness 11/14/2011f� LITTLE ROCK
HISTORIC
:-
DISTRICT
I ;, COMMISSION
DEPARTMENT OF PLANNING AND
DEVELOPMENT
723 West Markham Street
Little Rock, Arkansas 72201-1334
Phone: (501) 371-4790 Fax: (501) 399-3435
CERTIFICATE OF APPROPRIATENESS
AUTHORIZATION OF REPRESENTATION STATEMENT
11 hAA�)� . `J do hereby authorize
Property owner (print)
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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 Address:
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Title Holder's Signature
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Agent's Signature
Dat
l Date
Subscribed and sworn to me, a Notary Public on this /'� ay of eVerr-kern ql
MARILYN J WERS
Perry County
Notary Publk - Arkansas
My Commisslon Expires Feb 24, 2016
My Commission Expires: 2
Notary Publi
Revised 7/2009