HomeMy Public PortalAboutForm_Application_Exterior Alterations to Heritage Property_Effective 2016-08.pdf
REQUEST APPROVAL FOR EXTERIOR ALTERATIONS TO
MUNICIPALLY REGISTERED HERITAGE PROPERTY
Community Development Department
PO Box 369, 186 Central Street
Chester, NS B0J 1J0
E-mail: planning@chester.ca
Phone: 902-275-
2599
Fax: 902-275-2598
Office Use
Civic Address or Location of the Property: Application #:
PID #:
ZONE:
Civic Street Name Community Electoral District:
Electoral District:
Name of Property Municipally Registered? Yes □ No □
CONTACT INFORMATION:
Applicant Property Owner
Phone Phone
Email Email
Mailing Address Mailing Address
Postal Code Postal Code
You are the? □ Property Owner Correspondence to? □ Applicant
□ Contractor □ Property Owner
□ Other please
specify
□ Other (please
specify)
Briefly Outline Proposed Alterations: PLEASE ATTACH A PLAN OR SKETCH SHOWING YOUR PROPOSAL
Are plans for exterior changes available? Yes □ No □
Anticipated Start Date : YYYY / MM / DD Estimated Cost: $
Briefly Outline Need for Alterations:
Owner/Applicant Certification
I hereby certify that I am the owner of the land on which these alterations are proposed (□), or am making this
application with the consent of the owner (□). (Please check which is applicable) Date: YYYY / MM / DD
Signature:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Print Name:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Office Use
Application Considered by H.A.C. Date: YYYY / MM / DD
Application Approved by H.A.C. Date: YYYY / MM / DD
Application Approved by Council Date: YYYY / MM / DD
Signed by Clerk:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Date: YYYY / MM / DD