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LCityaf e Community Development <br />Louisvill <br />COLORADO -SINCE 1878 749 Main Street # Louisville CO 80027 # 303.335.4592 • www.louisvilleco.gov <br />HISTORIC PRESERVATION APPLICATION CASE NO: <br />PROPERTY INFORMATION <br />TYPE(S) OF APPLICATION <br />Address: /3�1 4LAU ,14- <br />❑ Probable Cause/Historic Structure <br />Assessment <br />❑ Landmark Designation <br />Year of Construction: _ I q,2 2^ <br />Legal Description: <br />❑ Historic Preservation Fund Grant <br />❑ Historic Preservation Fund Loan <br />❑ Landmark Alteration Certificate <br />Landmark Name and Resolution (if applicable): <br />D4 Demolition Review <br />❑ Other: <br />APPLICANT INFORMATION <br />REQUEST SUMMARY <br />�^'� <br />(Attach additional pages if necessary) <br />Name: �Z�(�iC.�;" <br />Company:�D)e- L <br />Address: <br />, �15.1tIle Go 5Af92T <br />Telephone: &03—gl2—C9 ) <br />Email: t��iD�ei5.Cr1YY1 <br />OWNER INFORMATION <br />SIGNATURES DATES <br />Name: �' L4t2f' Cc 5 �9G� - <br />SAAND <br />)' 'G'l.i J1�� <br />Applicant <br />Company: <br />, <br />scant Signature j Date <br />Owner ame G <br />Address: <br />Telephone: <br />Email: <br />,- <br />wn Signa ure Date <br />