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L LoLE" uiof e Community Development <br />svill <br />COLORADO -SINCE 1878 749 Main Street # Louisville CO 80027 # 303.335.4592 # www.fouisvilleco.gov <br />HISTORIC PRESERVATION APPLICATION <br />PROPERTY INFORMATION <br />Address: GOD V�fv CJl,�� <br />Date of Construction: 1((— <br />Legal Description: <br />Lot: Block: <br />Subdivision: <br />Landmark Name and Resolution (if applicable): <br />APPLICANT INFORMATION <br />Name: Vona 1 /kku) <br />Company: N /P\ � <br />Address: Goo ` <br />� t �2 ) �, <br />Telephone: 3D; 82 1 ` ` p <br />Email: ,)P3-t.b(I2compA.S�.Y�Ra <br />OWNER INFORMATION (IF DIFFERENT) <br />Name: <br />Company: <br />Address: <br />Telephone: <br />Email: <br />CASE NO. <br />TYPE(S) OF APPLICATION <br />r <br />Probable Cause%Historic Structure <br />Assessment <br />❑ Landmark <br />❑ Historic Preservation Fund Grant <br />❑ Historic Preservation Fund Loan <br />❑ Alteration Certificate <br />❑ Demolition Review <br />❑ Other: <br />REQUEST SUMMARY <br />SIGNATURES AND DATE <br />N i si-01, a A_ Mal C_o i vyn <br />Applicant Name (print) Date <br />Applicant Signature <br />Owner Name (print) Date <br />Owner Signature <br />