Street Address, City, State, Zip Code
(Street Address, City, State, Zip Code)
Subdivision Lot & Parcel # and/or Tax Map Designation
Check all applicable below:
including photographs, etc.
All adjacent property owners shall be listed. Adjacent property owners include all
property across from roadways, watercourses, railroads, and/or municipal boundaries.
The names and addresses below are those of adjacent property owners as listed in the tax
records of the City Assessor and County Assessor if applicable.
The Administrator on behalf of the Architectural Review Board will issue a certificate of Appropriateness, including all conditions of the approval once the application is reviewed.
This field is not part of the form submission.
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