Municipal Heritage Permit

 Form 26E Municipal Heritage Permit ‐ Application Form Property Owner’s Information Address of Designated Property: _______________________________________________________________________ Name of Property Owner: _____________________________________________________________________________ Mailing Address: ____________________________________________________________________________________ Telephone: __________________________________ Email Address: _________________________________________ Contact Person’s Information (if different than owner) Contact Name: _____________________________________________________________________________________ Telephone: __________________________________ Email Address: _________________________________________ Property Information Present Use of Building: _____________________________________________________________________________
Proposed Use of Building (if different from above): ________________________________________________________ Project Information Description of the Proposed Work: _____________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Has an application for a Building/Development Permit been submitted for this project? __________________________ Documents to Include at the Time of Application pictures of the exterior of the building a detailed scope of work (list of work to be done, step by step) documents explaining the project (drawings, product specification sheets, pictures of examples, etc.) Owner Signature: ______________________________________________ Date: ______________________________ Updated: January 2016