TOWN OF WETHERSFIELD
HISTORIC DISTRICT COMMISSION
Application for
CERTIFICATE OF APPROPRIATENESS
OFFICE USE ONLY OFFICE USE ONLY
Application No. Date Received
Application is hereby made for the issuance of a CERTIFICATE OF APPROPRIATENESS for proposed work
as described below and as shown on photographs and plans or drawings.
Address of Proposed Work
Applicant Phone
Applicant’s Street Email REQUIRED
City, State & Zip __________________________________ ________________________________________
Owner Phone
Owner’s Street Email REQUIRED
City, State & Zip __________________________________ ________________________________________
Agent or Contractor Phone
Street Email REQUIRED
City, State & Zip __________________________________
APPLICATION FEE: $25.00
THE FOLLOWING INFORMATION MAY BE REQUIRED (Please consult staff):
Photographs/Manuf. Cut Sheets Plot Plan of Property Plans/Drawings of proposed work
EXPLANATION OF APPLICATION:
Signature of Applicant
OFFICE USE ONLY OFFICE USE ONLY
( ) Referred to Historic District Commission for Public Hearing On
( ) Notice of Public Hearing published on
COMMISSION ACTION
( ) Application TABLED ( ) Application APPROVED AS SUBMITTED
( ) Application DENIED ( ) Application APPROVED AS MODIFIED
( ) Application CONTINUED WITH ( ) Application APPROVED WITH STIPULATIONS
HEARING LEFT OPEN
Date Date
Signed Signed
Clerk, Historic District Commission Clerk, Historic District Commission
03/24/20
