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Rouss City Hall
15 North Cameron Street
Winchester, VA 22601
Telephone: (540) 667-1815
Fax: (540) 722-3618
W
ebsite: www.winchesterva.gov
APPLICATION FOR HISTORIC BUILDING PLAQUE
(Application must be accompanied by 10 color photographs of each exterior facade)
Location of building:
Name of building (if applicable):
Date of construction:
Description of building, i.e., style, history, unique characteristics, both interior and exterior (use reverse side of this
form if necessary):
Description of restoration work completed (if applicable, include photographs of structure before and after
restoration):
Date restoration began:
Date restoration was completed:
Property owner:
Property owner's address:
Date of purchase:
Present use of property:
I (we)
Owners(s) of:
hereby apply for a Historic Building Plaque to be placed on said structure in a manner and location as prescribed by
the Board of Architectural Review. I understand that it is my responsibility to cause certification documents to be
recorded in the City Planner's Office of Winchester, and that once approved, I must order the plaque from the vender
and pay all applicable fees.
Signature of owner(s) Date
Phone number:
click to sign
signature
click to edit
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