LANDMARK. Planning, Zoning & Economic Development Department. 209 N. York Street Elmhurst, Illinois (630) (p) (630) (f) DATE

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City of Elmhurst Planning, Zoning & Economic Development Department LANDMARK APPLICATION 209 N. York Street Elmhurst, Illinois 60126 (630) 530-3100 (p) (630)782-6310 (f) CASE NUMBER UMBER: DATE APPLICATION FILED ILED: A. A. PROP ROPERTY INFORMATION Common Address of Property: _ Property Name (Historic and/or Common): _ Other / Previous Property Names: Property Identification Number (PIN): Legal Description (Attach additional sheets as necessary): _ B. NOMINA OMINATION MADE BY: Property Owner Historic Preservation Commission Local not-for-profit organization Mayor and/or City Council Elmhurst Resident Other Nominator Name: _ Nominator Address: Nominator City / State / Zip Code: Nominator Phone: Work: () Home: ()_ Mobil / Other: ( )_ Nominator Signature:

C. C. CURRENT PROPERTY OWNER INFORMATION Owner Name: Owner Address: Owner City / State / Zip Code: _ Owner Phone: Work: ()_ Home: () Mobil / Other: ( ) Owner Email: Owner Signature: D. D. PROPERTY CLASSIFICATION Category Ownership Status Present Use Existing Designation Building Public Occupied Residential National Register Structure Private Unoccupied Commercial State of Illinois Historic Landmark Site Industrial District Agricultural Object Educational Religious Government Other E. E. LANDMARK DESIGNATION CRITERIA Each proposed landmark must meet a set of criteria before the City can landmark a local site. Please mark which criteria most closely relates to your proposed landmark. If your proposal is not already on the National Register of Historic Places, please proceed to item number E.2. 1. To be eligible for landmark designation, a property, area, building, structure, object or site shall satisfy the two following criteria: a. be of an age of at least fifty (50) years; and b. be listed on the National or State Register of Historic Places, before the filing of an application of designation by the City; City of Elmhurst Landmark Application - 2

2. If the proposed landmark is not listed on the National or State Register of Historic Places, a proposed landmark designation, property, area, building, structure, object or site shall satisfy the following two criteria: a. be of an age of at least fifty (50) years; and b. have sufficient integrity of location, design, materials and workmanship to make it worthy of preservation or restoration; and MUST SATISFY ANY TWO (2) OF THE FOLLOWING ADDITIONAL CRITERIA: c. Distinctive architectural style (period, type, method of construction, materials); architecturally significant; example of best remaining architectural type in the City; d. Its location as a site of a significant historic or prehistoric event or activity which may or may not have taken place within or involved the use of any existing improvements on the property; e. Its identification with a person or persons who significantly contributed to the historic, cultural, architectural, archaeological or related aspect of the development of the City, State, Midwest Region or the United States; f. Its exemplification of an architectural type, style or design distinguished by innovation, rarity, uniqueness or overall quality of design, detail, materials or craftsmanship; g. Its identification as the work of an architect, designer, engineer or builder whose individual work is significant in the history or development of the City, the State, the Midwest Region or the United States; h. Its exemplification of important planning and urban design techniques distinguished by innovation, rarity, uniqueness or overall quality of design or detail; i. Its association with important cultural or social aspects or events in the history of the City, the State, the Midwest Region or the United States; j. Its location as a site of an important archaeological resource; unique location or established and familiar visual feature of a neighborhood; k. Its representation of a historic, cultural, architectural, City of Elmhurst Landmark Application - 3

archaeological or related theme expressed through distinctive areas, properties, structure, sites or objects that may or may not be contiguous; l. Its unique location or distinctive physical appearance or presence representing an established and familiar visual feature of a neighborhood, community or the City; m. Its exemplification of a pattern of neighborhood development or settlement significant to the cultural history or traditions of the City, whose components may lack individual distinction; n. Fine or unique example of a utilitarian structure; and o. It is likely to yield important information regarding Elmhurst history or pre-history. F. LANDMARK SIGNIFICANCE Provide a narrative, under separate cover, that describes how the proposed landmark meets the City s criteria for Landmark Designation. Please reference each criterion that is marked in Section E. Provide any additional information that relates to the proposed landmark. Areas of importance shall include, but not limited to, the following: Time period of significance for proposed landmark Historic function or use Significant events that occurred at, around or resulted in the proposed landmark Important persons associated with proposed landmark Detailed description of the physical characteristics of the proposed landmark, including the architectural style and materials used A list of significant exterior architectural features that should be protected Significant example or type of work by an architect Significant dates associated with the proposed landmark Detailed description of the property Description of the current condition of the proposed landmark and whether it has maintained its historical integrity in terms of location, design, materials, workmanship, etc City of Elmhurst Landmark Application - 4

G. LANDMARK APPLICATION CHECKLIST Completed Landmark application with authorized signatures Historic Landmark Agreement, executed by the property owner Written documentation and evidence establishing that the applicant(s) is/are the current owner(s) of record of the nominated property and that each owner of record consents to the proposed landmark designation. Such documentation or evidence of record ownership shall include a recent title policy in the name of the applicant or other evidence of ownership acceptable to City Attorney. In the event legal and equitable title is held by separate parties, written consent of each shall be required. Qualifying criteria for landmark designation and why the proposed structure meets such criteria. A written statement describing the structure, building, or site and setting forth reasons in support of the proposed designation, including a list of significant exterior architectural features that should be protected. An overall site plan (25 folded copies no smaller than 11 x 17 ) Photographs of the proposed landmark (25 copies) Front, side, and rear elevation drawing (25 folded copies no smaller than 11 x 17 ) Such other relevant information as requested by the City Attorney or the Historic Preservation Commission $100 filing fee, payable to the City of Elmhurst. If the form is prepared and submitted by the current property owner, no fee is required. City of Elmhurst Landmark Application - 5

HISTORIC LANDMARK AGREEMENT The undersigned owner(s) hereby grant(s) permission for the property located at to be considered for local historic landmark preservation, pursuant to the Elmhurst Historic Preservation Ordinance. I understand that upon designation, I or my successors will be obligated to secure a Certificate of Appropriateness from the Historic Preservation Commission or the City of Elmhurst prior to the occurrence of any of the following: 1. Major changes by addition, alteration, maintenance, reconstruction, rehabilitation, renovation or repair 2. Any new construction and demolition in whole or in part requiring a permit from the City; 3. Moving a building; or 4. Any construction, alteration, demolition, or removal affecting a significant exterior architectural feature as specified in the ordinance designating the landmark, including but not limited to changes to the roofline. I also understand that this designation transfers with the title of the property should the property be sold, or if legal or beneficial title is otherwise transferred. Dated this day of, 20. Owner(s) Name (please print) Owner(s) Signature State of ) County of ) ss). Subscribed and sworn to me this_ day of, 20. Notary Public City of Elmhurst Landmark Application - 6