HPC 630 Main St.pdff,11% Edmonds
Edmonds Register of
Historic Historic Places
Preservation g
Commission Nomination Form
Type or print all entries — Please complete all applicable sections.
A „Site Name, / Location m ��
FOR OFFICE USE ONLY
Date Received: 'j, iL - l
Received by: '
File#: P 4 te` 1
Survey/Site #:
Historic Name (if applicable):
Common (or Current) Name (if applicable):"d''11
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Site Address / Location
Street Address or Location Description: 40'30 14,41A) r
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City / ZIP Code: . )''/t; A)` &(, Tax / Parcel Number (' i 17W (1
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BProperty Owner _ w _S41e
Street Address: & _Y) _i":
City / State / ZIP Code: " tt ¢,VAt Phone #: ✓l _.Y7
Name (say "Owner" if same as owner listed above): 6 U)A,,
Contact Address: Street:
Contact Phone #:
Date Form Completed:
City / ZIP:
D��Consent_to_be Listedr,(Optional Notvrequ�red zfor a nomina#ion) �� � � ��
I / WE the undersigned certify that we are the owners of the property identified on this form and hereby give our
consent to having the property listed on the Edmonds Register of Historic Places.
Name (Please Print) --�. -. /W. A,/A(�
Signature C t' L ' Date
Name (Please10'n/t) J A10kA f lLe� Lij
Signature Date
/ j�
Revised on 9/14/10 P40 - Historic Register Nomination Forin Page 1 of 5
Site is listed on the National Register of Historic Places (If checked, skip to Section F)
Site is listed on the State Register of Historic Places (If checked, skip to Section F)
Historical Significance — Please check all that apply:
1. � Is associated with events that have made a significant contribution to the broad patterns of national, state or local
history.
2. Embodies the' distinctive architectural characteristics of a type, period, style or method of design or construction, or
j represents a significant and distinguishable entity whose components may lack individual distinction.
3. Is an outstanding work of a designer, builder or architect who has made a substantial contribution to the art.
4. Exemplifies or reflects special elements of the city's cultural, special, economic, political, aesthetic, engineering or
architectural history.
5. Is associated with the lives of persons significant in national, state or local history. — Al I(,�Glc 1l
1 i0 .V Uh. 1� lVW
6. , Has yielded or may be likely to yield important archaeological information related to history or prehistory.
/
7. 1 Y 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.
8. Al Is a birthplace or grave of a historical figure of outstanding importance and is the only surviving structure or site
associated with that person.
9. AV/ Is a cemetery which derives. its primary significance from age, from distinctive design features, or from association
with historic events or cultural. patterns.
10. Al Is a reconstructed building that has been executed in a historically accurate manner on the original site.
11. 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; the
designation shall include description of the boundaries. —POP- Y; T NOT- S-eg t:„
Historical Description
c?
In the space below, describe the history and significance of the site to Edmonds' heritage. You may elect to
describe the site's significance in your own words, attach copies of other documents or photographs, and/or make
reference to other materials (noting where those materials are available to be reviewed). For example, you may
simply note that the site is on an historical survey, noting the survey name and site number. (Please feel free to
attach any additional continuation sheets if you need more space.)
14A l eq.J di9 lA6 /ZS Co✓�i�l �1v�
yam; lT .�
Z11 -A(- T/46es
Revised on 9/14/10 P40 - Historic Register Nomination Form Page 2 of 5
---------------------------------------------------------------------------------------- -------------------------------------------
Describe the present and original (if known) physical appearance:
(Use continuation sheets if necessary, andfor any photographs or copies you are providing.)
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(Please list and reference any sources which help document the historical value of the site)
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Location Detail
Parcel #
UTM Reference:
Township
Category
District
Building(s)
Structure
Site
Object
Within a District?
Yes
No
Zone Easting
Range:Section
Ownership
Public
Private
Both
Contributing?
Yes
No
Unknown
National or State Register / District:
Revised on 9114110 P40 - Historic Register Nomination Form Page 4 of 5
Northing _
'/4 Section
`/4'/4 Section—
Resource Status
Usage
Survey/Inventory
Current:
National Register
National Landmark
State Register
Historic:
Determined Eligible
Other:
Local District:
National or State Register / District:
Revised on 9114110 P40 - Historic Register Nomination Form Page 4 of 5
This section must be completed if the site is not on the State or National Register, or it is not on an approved historic survey.
Please provide as much information as you can.
Year Built: , Architect: b /iJ" J
Builder or Engineer (specify): 1.1A,
Architectural Styles)*: Building Form*:
Roof Type*: A:sPl-,4t-r �")A &:�- Cladding*: -PA/roL&a�
* Note: See later reference sheets for list of choices for these items.
------------------------------------------------------------------------------------------------------------------------------------
Overall
Changes from
_ Hexagonal _
Square
_ H -Shape _
Con
Original:
T -Shape
_ L -Shape _
Unknown
-d—itio—n:
7 Excell ent
Plan:
Cladding:
Windows: Other: Site:
Good
Intact
Intact
Intact
Intact Original Site
Fair
Slight
Slight
Slight
Slight Moved
Deteriorated
Moderate
Moderate
Moderate
Moderate Date Moved:
Ruins
Extensive
Extensive
ZExtensive
Extensive
Unexposed
Unknown
Unknown
Unknown
Unknown
------------------------------------------------------------------------------------------------------------------------------------
Plan Type:
Structural System:
Foundation:
Roof Material:
_ Apsidal
_ Pavilion
_Balloon/Platform
_Brick
a/Asphalt Comp _ Metal – Tile
_ Center Space/
_ Polygonal
_Braced Frame
a/Concrete block
_ A. Comp - built up _ None
Courtyard
_ Rectangle
_Brick
✓Concrete poured
_ A. Comp - shingle _ Other
Cross/Cruciform
Round
Clay Tile
Log
A. Comp – rolled Slate
_ E -Shape _
Semi -circular
_ Hexagonal _
Square
_ H -Shape _
Triangular
_ Irregular _
T -Shape
_ L -Shape _
Unknown
None _
U -Shape
Octagonal _
Y -Shape
1// Other
Wood shake
&-64 jlt Mfl/ �
_Stone
Number of StoriesTl-
an tdtlr
_ Concrete block
_None
Tile
Unknown
_Concrete poured
_Other
—Tile -clay _
Wood
_Log
_Parged
_ Tile - concrete _
Wood plank
_Mixed
_Post & Pier
Metal
Wood shake
_None
_Stone
_ Metal - corrugated _
Wodd shingle
_Other
_Unknown
_ Metal - standing seam
Plank
_Post & Beam
_ Steel
Stone - cut
Stone - uncut
Unknown
Revised on 9/14/10 P40 - Historic Register Nomination Form Page 3 of 5
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