HZC Preliminary Evaluation Questionnaire

1. Historic Zoning Commission Preliminary Evaluation Questionnaire

The information provided in this form will assist the Knoxville or Knox County Historic Zoning Commission staff in evaluating a property's eligibility for a local historic or neighborhood conservation overlay. It is not an application form. If the property appears to meet the criteria for local listing, HZC staff will contact you.

If you have questions about this questionnaire, contact Historic Zoning Commission staff at (865) 215-2500.

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1. Property name and location

Name of the property: *

Address: *

Address 2:

City/Town: *

ZIP: *

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2. Original use:

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3. Present use:

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4. Date(s) of construction and of any major changes:

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5. Owner information:

Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP/Postal Code: *

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6. Original or other historically notable owner or occupant:

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7. Architect or builder:

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8. Why is the property historically or architecturally important?

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9. Briefly describe the property. (Describe the original form and any major changes, inside and out, that may have occurred. Be sure to point out any notable features. If the property includes outbuildings or notable landscape features, mention them also.)

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10. Are there plans for the rehabilitation or renovation of the property in the near future? If so, please decribe them.

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11. Is the propety endangered? If so, explain.

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12. Contact information of the person submitting this questionnaire:

Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP/Postal Code: *

Email Address:

Phone Number:

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13. Submitter's interest in the property:

Owner

Renter

Relative of owner

Local historian

Other (please specify)

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14. If the person submitting this form is not the property owner, has the owner been contacted and does the owner consent to the consideration of this property as a designated local landmark?

	Yes	No
Contacted	Contacted Yes	Contacted No
Consents	Consents Yes	Consents No

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1. Property name and location

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2. Original use:

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3. Present use:

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4. Date(s) of construction and of any major changes:

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5. Owner information:

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6. Original or other historically notable owner or occupant:

Question Title

7. Architect or builder:

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8. Why is the property historically or architecturally important?

Question Title

9. Briefly describe the property. (Describe the original form and any major changes, inside and out, that may have occurred. Be sure to point out any notable features. If the property includes outbuildings or notable landscape features, mention them also.)

Question Title

10. Are there plans for the rehabilitation or renovation of the property in the near future? If so, please decribe them.

Question Title

11. Is the propety endangered? If so, explain.

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12. Contact information of the person submitting this questionnaire:

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13. Submitter's interest in the property:

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14. If the person submitting this form is not the property owner, has the owner been contacted and does the owner consent to the consideration of this property as a designated local landmark?

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15. Date questionnaire was submitted: