NUTLEY HISTORIC PRESERVATION COMMITTEE

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NUTLEY HISTORIC PRESERVATION COMMITTEE ARCHITECTURAL LANDMARKS DESIGNATION REVIEW SHORT FORM CONTACT INFORMATION Name: Address: Phone: email: HOUSE APPLICATION Name: ____________________________________ would like to request consideration for inclusion in the Nutley Historic Preservation Committee list of Historic Places. The property is located in Nutley at ___________________________________________

_________________________________________________________________________ Signature Date

ADDITIONAL INFORMATION (fill in anything available) Year built _________ Style

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Architect

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Special features

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List anything that makes your home particualary significant to Nutley history _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

Other comments _______________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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