Historic Project Name Current Project Name Address __________________________________________ City __________________ ZIP __________ Original Architect and/or Builder Architectural Style ___________________________________ Date of Original Completion Landmark Designations, if relevant (check all that apply) Locally Designated In Local Historic District In National Historic District    Listed in CA Register Eligible for CA Register CA Point of Historical Interest     Listed in National Register  Eligible for National Register  National Historic Landmark Project Type (check one) Residential Commercial Institutional Landscape      Plan/Policy/Study  Educational  Grassroots  Other: Project Start Date (Month/Year) _____________________ Project End Date (Month/Year) _____________ Application submitted by: Name Company Address __________________________________________ City __________________ ZIP __________ Daytime phone _____________________ Email address ________________________________________ $75 nonrefundable processing fee submitted by: Check enclosed (payable to L.A. Conservancy) Paid online at  
Historic Project Name Current Project Name Address __________________________________________ City __________________ ZIP __________ Original Architect and/or Builder Architectural Style ___________________________________ Date of Original Completion Landmark Designations, if relevant (check all that apply)  Locally Designated  In Local Historic District  In National Historic District  Listed in CA Register  Eligible for CA Register  CA Point of Historical Interest  Listed in National Register  Eligible for National Register  National Historic Landmark Project Type (check one)  Residential  Commercial  Institutional  Landscape  Plan/Policy/Study  Educational  Grassroots  Other: Project Start Date (Month/Year) _____________________ Project End Date (Month/Year) _____________ Application submitted by: Name Company Address __________________________________________ City __________________ ZIP __________ Daytime phone _____________________ Email address ________________________________________ $75 nonrefundable processing fee submitted by:  Check enclosed (payable to L.A. Conservancy)  Paid online at