Department of Planning and Development
Historic Preservation Design Guidelines
Application for a Certificate of Historic District Appropriateness
Date: Fee:
A:     Information on Structure Under Consideration
Address:
Date Purchased: Current Owner:
Date Constructed: Original Owner (if known):
This document does not constitute the issuance of a Building Permit. It is the responsibility of the applicant to obtain all necessary permits before commencing work.
Contact Inspections Department: 252-975-9352 / 252-975-9304.
Has a Building Permit been obtained?      YES ______     NO ______     N/A ______
B:     Information for Person Making Application
Name:
Mailing Address:
City, State ZIP:
Phone:
C:     Proposed Changes to Structure
(I) (We) respectfully request a Certificate of Appropriateness by issued in accordance with the City of Washington Zoning Ordinance for the following reasons:

D:     (I) (We) understand approved requests are valid for one (1) year.

NOTE: APPLICANTS, AND/OR THEIR AGENTS OR PARTIES OF INTEREST, ARE PROHIBITED FROM ANY CONTACT IN RELATION TO THIS MATTER WITH HISTORIC PRESERVATION COMMISSION MEMBERS PRIOR TO THE PUBLIC HEARING.

Respectfully submitted,                       

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