HomeMy WebLinkAboutHDC2012-008 Final Action3•
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LITTLE ROCK
HISTORIC
DISTRICT
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
r
do hereby authorize
Property owner (print)
to represent me and my interests in an
Agent/representative ria a 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 Il'Address:
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r%nfl 21/97ifAfa ZA— 77-�p��
Title Holder's Signature Date
Agent's Signature Date
Subscribed and sworn to me, a Notary Public on this day of ,
My Commission Expires:
Notary Public
Revised 6/2011