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WCity0f Community Development <br />Louisville <br />COLORADO • SINCE 1878 749 Main Street + Louisville CO 80027 o 303.335.4592 # www.louisvilleco.gov <br />HISTORIC PRESERVATION APPLICATION CASE NO. <br />PROPERTY INFORMATION <br />TYPE(S) OF APPLICATION <br />Address: ,_ q r non% 611L <br />❑ Probable Cause/Historic Structure <br />Date of Construction: <br />Assessment <br />Legal Description: <br />Lot: Black: <br />Subdivision: e� �T ;�/ _ <br />L]el Landmark <br />90" Historic Preservation Fund Grant <br />❑ Historic Preservation Fund Loan <br />LJ Alteration Certificate <br />EB/ <br />Landmark Name and Resolution (if applicable): <br />❑ Demolition Review <br />❑ Other: <br />APPLICANT INFORMATION <br />REQUEST SUMMARY <br />Name: <br />Company: <br />Address: <br />Telephone: <br />Email: <br />OWNER INFORMATION (IF DIFFERENT) <br />SIGNATURES ANDDATE <br />Name: <br />r�yty I I ! a rl>10 e/u/.2 <br />� <br />_ �cZ <br />Company: <br />Ap c nt Name (print Date <br />Address: <br />A plicant Signature <br />I /I A -.0- Mdrmo &Igq O <br />Ow er me {print) Date <br />Telephone: <br />Email: <br />Owner Signature <br />