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,L City,/ <br />Im Louisville <br />COLORADO • SINCE 1878 <br />Community Development <br />749 Main Street ' Louisville CO 80027 • 303.335.4592* www.louisvilleco.gov <br />HISTORIC PRESERVATION PROGRAM INTAKE FORM <br />ADDRESS APPLICATION TYPES <br />APPLICANT INFORMATION <br />Name: <br />Address: <br />Telephone: <br />Email: <br />Applicant Signature: <br />OWNER INFORMATION (if not applicant) <br />Name: <br />Address: <br />Telephone: <br />Email: <br />Owner Signature: <br />❑ Historic Structure Assessment <br />❑ Landmark <br />❑ Historic Preservation Fund Grant <br />❑ Historic Preservation Fund Loan <br />❑ Alteration Certificate <br />❑ Demolition Review <br />NOTES <br />CERTIFICATIONS: <br />By initialing below, I certify that: <br />- I understand that any grants provided by <br />the City may be counted as income for tax <br />purposes. <br />- I am the owner of the property at the <br />address above, or have been authorized <br />by the owner to make an application. <br />- I understand that only the property owner <br />may be reimbursed for any and all grants. <br />