CERTIFICATE OF APPROPRIATENESS (COA) APPLICATION
City of Bellevue – Historic Preservation Office
616 Poplar Street – Bellevue, KY 41073
Phone: (859)-431-8866
Fax: (859)-261-8387
Email:
***APPLICATION SHALL BE SUBMITTED NO LATER THAN THREE (3) DAYS PRIOR TO
MEETING DATE***
COA Application #: _______________
PROPERTY IMPROVEMENT INFORMATION
Property Address:
Bellevue, KY 41073
Current Use:
Describe work proposed below and attach additional plans
IMPROVEMENT TYPE / WORK DESCRIPTION
(i.e. materials, design drawings, specifications, photos, etc.)
Alteration (visible changes to exterior)
General Maintenance
Re-Roofing,
Wood Repair,
Exterior Painting,
Misc.
Other Modifications
Pools, Fencing, Driveways, Landscaping, etc.
New Construction
New Building,
Addition,
Accessory Structure
Demolition
ESTIMATED COST: $ ____________________________
APPLICANT INFORMATION
(PLEASE PRINT)
Applicant is
Owner
Contractor
Architect
Consultant
Other
Owner’s Name: ____________________________________
Address: __________________________________________
City: __________________ State: _______ Zip: __________
Telephone: _________________ Cell: __________________
Email: ____________________________________________
Applicant’s Name: __________________________________
Address: __________________________________________
City: __________________ State: _______ Zip: __________
Telephone: _________________ Cell: __________________
Email: ____________________________________________
Contractor: ________________________________________
I have reviewed the Bellevue Design Guidelines
Contact: __________________________________________
Occupational License #: _____________________________
I or my representative will attend the Historic
City: __________________ State: _______ Zip: __________
Preservation Commission Meeting
Telephone: _________________ Cell: __________________
I am applying for Federal or State Historic
Preservation Tax Credits
Email: ____________________________________________
I understand this application will not be accepted and processed until all the requested information has been
supplied, including any additional plans. Failure to supply adequate additional plans could result in processing
delays and/or denial of request. I also understand this application may require a site visit/additional information
and a public hearing by the Bellevue Historic Preservation Commission. I hereby certify that as an applicant for
this Certificate of Appropriateness I will comply with all applicable laws and codes, including building permits,
and make the proposed improvement according to the COA permit.
_______________________________________
_______________________________________
SIGNATURE OF OWNERS(S)
DATE
SIGNATURE OF AGENT(S)
DATE
1
