Historic Plaque Program Application

 

 

Date:                                               

 

Name of Applicant(s):                                                                                                                  

 

Applicant Mailing Address:                                                                                                       

 

Phone Number:                                                                                                                              

 

Email:                                                                                                                                               

 

Address of Historic Structure:                                                                                                    

 

Date of Construction:                                                                                                                    

 

Historic Function:                                                                                                                          

 

Current Function:                                                                                                                           

 

Complete the above application and please attach a Written Description of the Structure (the narrative should explain the archaeological, historical, architectural, or cultural significance of the proposed landmark) and one (1) photo of the front elevation and a historical photo is available.

 

If you have any questions regarding the Historic Plaque Program or need an appointment to submit your application, please contact the Planning & Zoning office at: (352) 528-3060, Option #3.