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Historic Preservation Program PUYALLUP REGISTER OF HISTORIC PLACES NOMINATION FORM This form is required to nominate properties to the Puyallup Register of Historic Places per P.M.C. 21.22. Please type all entries and complete all applicable sections. Illegible applications will be returned. Contact Puyallup Department of Development Services with any questions at [PHONE REDACTED]. PROPERTY INFORMATION Property Name Historic: Common: Location Street Address: Zip Code: Parcel No: Legal Description: Nominated Elements – Please indicate below significant elements of the property that are included in the nomination by checking the appropriate box (es) below. These elements should be described specifically in the narrative section of this form. Principal Structure Site Historic District Historic Landscaping, Fencing, Walkways, etc. Ancillary Buildings Other (inventory in narrative) Owner of Property Name: Address: City, State, Zip code: Is the owner the sponsor of this nomination? Yes No Form Preparer Name: Company/Organization: Address: City, State, Zip code: Phone Email: Nomination Checklist – Attachments Site Map (REQUIRED) Photographs (REQUIRED): please see photo guide for additional details Last Deed of Title (REQUIRED): this document can usually be obtained for little or no cost from a titling company Continuation Forms Other (please indicate): FOR OFFICE USE Date Received: Nominations to the Puyallup Register of Historic Places are processed according to the procedures and standards described in P.M.C. 21.22. Submittal of a nomination form does not obligate the city to place a property on the Register or to extend financial incentives to a property owner. Documents submitted become public record. Additional requirements may be imposed by other city, state, or federal regulations. ---PAGE BREAK--- Extent of Changes – Please summarize the changes to plan, original cladding, windows, interior and other significant elements by selecting the choices below. If the property has been previously documented, these may be indicated on the Washington State Historic Property Inventory Form. These changes should be described specifically in the narrative section of this form. Original Materials Intact Plan no additions to footprint, relocation of walls or roof plan) Yes No Original Cladding Yes No Windows (no replacement windows or replacement sashes) Yes No Original Materials Intact Interior (woodwork, finishes, flooring, fixtures) Yes No Other elements Yes No Physical Description Narrative – Describe in detail the present and then the original (if known) physical appearance, current appearance and architectural characteristics (use continuation sheets if necessary). Nominations to the Puyallup Register of Historic Places are processed according to the procedures and standards described in P.M.C. 21.22. Submittal of a nomination form does not obligate the city to place a property on the Register or to extend financial incentives to a property owner. Documents submitted become public record. Additional requirements may be imposed by other city, state, or federal regulations. ---PAGE BREAK--- HISTORICAL OR CULTURAL SIGNIFICANCE Criteria for Designation Puyallup Municipal Code recognizes 11 criteria of eligibility for inclusion on the Puyallup Register of Historic Places. Please select any that apply to this property, for which there is documentary evidence included in this nomination form. A Is associated with events that have made a significant contribution to the broad patterns of national, state, or local history; or B Embodies the distinctive architectural characteristics of a type, period, style, or method of design or construction, or represents a significant and distinguishable entity whose components may lack individual distinction; or C Is an outstanding work of a designer, builder, or architect who has made a substantial contribution of art; or D Exemplifies or reflects special elements of the City’s cultural, social, economic, political, aesthetic, engineering, or architectural history; or E Is associated with the lives of persons significant in national, state, or local history; or F Has yielded or may be likely to yield important archaeological information related to history or prehistory; or G Is a building or structure removed from its original location but which is significant primarily for architectural value, or which is the only surviving structure significantly associated with a historic person or event; or H Is a or grave of a historical figure of outstanding importance and is the only surviving structure or site associated with that person; or I Is a cemetery which derives its primary significance from age, from distinctive design features, or from association with historic events, or cultural patterns; or J Is a reconstructed building that has been executed in a historically accurate manner on the original site; or K Is a creative and unique example of folk architecture and design created by persons not formally trained in the architectural or design professions, and which does not fit into formal architectural or historical categories. Historical Data (if known) Date(s) of Construction Other Date(s) of Significance Architect(s) Builder Engineer Nominations to the Puyallup Register of Historic Places are processed according to the procedures and standards described in P.M.C. 21.22. Submittal of a nomination form does not obligate the city to place a property on the Register or to extend financial incentives to a property owner. Documents submitted become public record. Additional requirements may be imposed by other city, state, or federal regulations. ---PAGE BREAK--- Statement of Significance Describe in detail the chronological history of the property and how it meets the criteria for the Register of Historic Places. Please provide a summary in the first paragraph (use continuation sheets if necessary). If using a Multiple Property Nomination that is already on record, or another historical context narrative, please reference it by name and source. Please provide a bibliography for books and other materials accessed. Nominations to the Puyallup Register of Historic Places are processed according to the procedures and standards described in P.M.C. 21.22. Submittal of a nomination form does not obligate the city to place a property on the Register or to extend financial incentives to a property owner. Documents submitted become public record. Additional requirements may be imposed by other city, state or federal regulations.