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1 CITY OF REDMOND LANDMARK NOMINATION FORM Name of Property Historic Name: Current/Other Names: Location Street & Number (if site has no address give general vicinity description) City: Redmond State: WA Zip Code: 98052 County: King Yes No Does this site have restricted access? i.e. needs special card for entrance. Is this address OK for publication? Note: Historic properties may be featured on City web site or tourism pamphlets. If you do not want the address publicized in such places please indicate. Geographic Data /Legal description Property tax ID/s Acreage of property: USGS Quadrangle Name: Verbal boundary description or legal description: If the boundary differs from the entire property reason for choosing this boundary: ---PAGE BREAK--- 2 Owner of Property Owner must consent to the nomination. The signature of all owners must be obtained. Note: If there are additional owners please submit on an additional sheet. Form prepared by Classification (Choose one) Category of Property Ownership of Property Building private Structure (i.e. bridge) public (if public name of public agency) Object (i.e. statue, grave marker) Archeological Site Cemetery/burial site Landscape Owner: Street Address: City: State: Zip: Signature Owner: Street Address: City: State: Zip: Signature Name/title if any: Organization (if applicable) Street Address: City: State: Zip: Telephone: Date ---PAGE BREAK--- 3 Function or Use (consult with preservation staff or see list on State Office of Archeology and Historic Preservation web site) Historic Function/s or Use/s Current Function/s or Use/s Description (if not familiar with architectural descriptions and common nomenclature or terminology consult with preservation staff for assistance) Current Condition: General Integrity Bldg/Structure/Object EXCELLENT ALTERED ORIGINAL SITE GOOD UNALTERED MOVED FAIR DETERIORATED Date Builder/Architect Architectural Classification Materials Narrative: Describe the present and historic physical appearance of the property. foundation: walls: roof: other: If necessary use continuation sheets. ---PAGE BREAK--- 4 Area of significance Applicable Designation Criteria Is associated in a significant way with, a historic event that had a significant effect upon national, state, or local history; or Is associated in a significant way with the lives of persons important in national, State or local history; or Embodies the distinctive architectural characteristics of type, period, style, or method of design or construction and is one of only a few examples of its typology in the City or Eastside region or is a contributing feature of a historic district; or It represents a notable work of a builder, designer, or architect who has made a substantial contribution to their field; or Has other historic significance. Statement of Significance. Note: It is suggested that you include the following types of information in narrative to support that the designation criteria are met: o Period of significance o Significant Dates that are related to property o Architect/Builder if applicable o Significant Person/s if applicable o Cultural Affiliations If necessary use continuation sheets. ---PAGE BREAK--- 5 Documentation Bibliography: Cite any books, articles, and other sources used in preparing this form. Note any oral histories or interviews used in preparing this form. Note if any documentation is on file. i.e. Local government inventory/survey record, University, State Office Maps and Photographs: Provide current photos and, if available, historic photos. Provide a parcel map with the location of the property and its boundaries clearly marked. O:\PCFORMS\Application Requirements\Landmark Nomination Form.doc Rev 6/2006