145 NE 94 St (11)' "13 PAi► ■e2 3 r.cKS CTrsecPj
MIAMI SHORES VILLAGE HISTORIC PRESERVATION BOARD
APPLICATION FOR A
CERTIFICATE OF APPROPRIATENESS
please type or print clearly
NAME OF PROPERTY (if applicable) : 6 1 0 WIZ r /Vein we r osS44-rf)
ADDRESS OF PROPERTY: /t{ S /I I q'% S7Leeel fl hi, S oyos 33 38
NAME(S) OF APPLICANT(S): F2 E / CL L . /V &W)1IO_-
(NOTE: IF THE APPLICANT IS A PERSON
OTHER THAN THE OWNER(S) . EVIDENCE // /r OSS' X a r � t
OF THAT PERSONS AUTHORITY AS AGENT de/y.9,4 k . () `
MUST BE ATTACHED TO THE APPLICATION.)
TELEPHONE OF APPLICANT(S): (305) 7,5 / O ?3 ; (305)
ADDRESS OF APPLICANT(S): S 4- i'i E A carQsS
(if different than address of property)
PRESENT USE OF PROPERTY: e s r
CLASSIFICATION OF WORK FOR WHICH CERTIFICATE IS DESIRED:
(circle the letter next to the appropriate classification)
A. MAINTENANCE OR REPAIR: The act or process of applying measures to sustain the existing li>rm, integrity and
material of a building or structure and the existing form or vegetative cover of a site. It may include initial stabilization work.
where necessary, as well as on -going maintenance and repair. Samples of material must be submitted with the Application.
RESTORATION: The process of accurately recovering the form and details of a property and its setting as it appeared at
a particular period of time by means of the removal of later work or by the replacement of missing earlier work. All
applications for restoration shall include site plans (if required by the Building Permit), a statement with bibliography
historically justifying the work. and any additional photos or information to support the proposed work.
C. REHABILITATION: The process of returning a property to a state of utility through repair or alteration which makes
possible an efficient contemporary use while preserving those portions or features of the property which are significant to its
historical. architectural and cultural values. All applications for rehabilitation shall include: site plans (if required by Building
Permit). and any other supplementary intimation, such as drawings, that will support the proposed project.
D. DEMOL'I'TION: The process of destroying or tearing down a building or structure or a part thereof, or the process of
removing or destroying an archeological site or a part thereof: The applicant shall include a report explaining why the proposed
action should occur. If this action is to occur for reasons of financial hardship. all pertinent financial data should he included
pertaining to the cost of preservation. demolition and new construction. Any other material pertinent to the application is also
encouraged as supplementary information.
NEW CONSTRUCTION: The process uf'constructing a building Or structure that has never existed thpt location.
Applicaq ons shall ' elude : a site plan. elevations, Floor plan and/or landscape plan. t !/
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DESCRIPTION OF THE PROPOSED PROJECT (Explain what changes will be made
and how they will be accomplished - use continuation sheet if necessary all applications
shall be accompanied by at least one 3" x 5" photograph of the property):
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CERTIFICATION ��
I (WE) CERTIFY TO TIME BEST OF MY (OUR) KNOWLEDGE AND BELIEF THAT ALL INFORMATION IN
THIS APPLICATION AND ITS ATTACHMENTS IS TRUE AND CORRECT:
SIGNATURE OF APPLICANT(S):
SIGNATURE OF OWNER(S):
FOR BOARD USE ONLY
APPLICATION DATE (date application received by Secretary of the Board):
DECISION OF THE BOARD (circle the appropriate number):
1. APPROVED
PROVED WITH CONDITIONS (set forth conditions below):
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SIGNATURE OF CHAIRMAN:
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DATE: 0-05
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DATE:
DATE: 5/(4-
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