SR-406-002 (3)
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City of
Santa Monica
Pl.anning and Community Development Department
City Planning Division
(310) 458-8341
MILLS ACT CONTRACT APPLICATION
(Please Type or Print All Information)
Application Number (s)
Filed :y 1- ~J ~ I
Fee
Receipt
By tJ L-
.~~
PROJECT ADDRESS' '2-q.o~ 4'1'h Sf. #14- fAMI\ II1GlJI<.A ~ qo<t-oS
/
Land Use Element District
Zoning District
Legal Description (Lot, Block, Tract)
Legal Description (Book, Page, Parcel #)
[Please attach copy of legal description. Generally this is "Exhibit A" on a Deed.]
APPLICANT .s H E-/ U\ NAYIl1.<\ I\J
Address ~ 2 w2.. 4'A.rr ~ 14 Phone '];/0 - 2fl1- -1-'11..1.
Santa Monica Business License No.
CONTACT PERSON ~H C/(}l A~ 'f(tlAN
Address '24-f,JL 4't" J'T -14 I 4-
Phone '3:-10 - 3~ 1- -1~'L'1.
Santa Monica Business License No.
DESIGNER/ARCHITECT
Address
Phone
Professional License Number
Santa Monica Business License No.
ATTORNEY
Address
Phone
Santa Monica Business License No.
PROPERTY OWNER S HB {A 1J~'f""AN
Address '2-401- ~ f-r .# 14
PhoneJ10- -111..-'1Cf1-1
I Certify that this application is being made with my consent.
PROPERTY OWNER'S S[GNAT~3
Existing Use of Property ~t.S'.DtN71~ L
Rehabilitation or Maintenance Needed fVlAINTENAN(~
(Attach either the Rehabilitation or Maintenance Plan, as appropriate.)
laAl-
')
Date of Local Designation. _'1.113110
Is the property. designated a~ part of an historic district? ~ If so, what district? _
Is the property listed on the National Register of Historic Places? Yes. No
Is the property listed as part of an historic district?
. If so, what district?
Please also attach:
1. A restoration/rehabilitation plan for the designated historic property; if the building is
already restored and in good condition, a maintenance list must be submitted to support
the need for tax relief.
2. A cost estimate of the restoration/rehabilitation plan from a certifed architect.
3. A completed Financial \nalysis of Mills Act Contract form.
4. Photographs of all building elevations and character defining features using 35 mm. black
and white film.
I certify that the information contained in the application is correct to the best of my
knowledge and that this application is made with the knowledge and consent of the
property owner.
APPLICANT'S SIGNA~~
DATE~ /1- /99
Driver's License Number: A q-ff J 11 r- State: VI
Expiration Date: I /. J 0 I '200 'r
i
f:\plan\share\lmk\millsapp
k111/28/95
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