2. This application is for smaller-scale projects affecting historic properties that are listed on the Manhattan Register of Historic Places or in a district on the Manhattan Register of Historic Places requiring a Certificate of Appropriateness before the work may begin. Examples include signs, small additions, interior renovations, modifications or demolition of accessory structures, and some zoning actions. This form must be submitted and you must receive a Letter of Approval regarding the project before a permit can be issued. Contact Ben Chmiel at (785) 587-2438 or chmiel@cityofmhk.com with any questions.
4. Date*
   Date
5. Historic Property Address*
6. Historic District
   -- Select One --Lee Elementary NeighborhoodNot in a District
8. Applicant Information
10. First Name*
11. Last Name*
12. Company (if applicable)
14. Address*
15. City*
16. State*
17. Zip
19. Phone*
20. Email*
22. Property Owner Information
24. First Name*
25. Last Name*
26. Company (if applicable)
28. Address*
29. City*
30. State*
31. Zip
33. Phone
34. Email
36. Project Description
38. Type of work proposed (check all that apply)*

    1. Alterations
    2. Building Permit
    3. Demolition Permit
    4. Sign Permit
    5. Zoning Action
    6. Other Alterations
    7. N/A
40. Please describe in detail the project you are proposing*
42. Photo Upload
    Please upload up to twelve high quality photos below (at least 1 MB each) of the existing property, including the exterior of the property and any areas or features proposed to be modified as part of the project.
44. Photo 1
45. Photo 2
46. Photo 3
48. Photo 4
49. Photo 5
50. Photo 6
52. Photo 7
53. Photo 8
54. Photo 9
56. Photo 10
57. Photo 11
58. Photo 12
60. Document Upload
    Please upload any site plan drawings, sketches, sign renderings, or any other documents depicting proposed modifications to the property. PDFs are preferred. Upload up to six.
62. Document 1
63. Document 2
64. Document 3
66. Document 4
67. Document 5
68. Document 6
70. Please sign this form by entering your first and last name below
    Within two days of submission, you will be contacted via the applicant email address you provided regarding a determination on your project. Note that more information or documentation may be requested before a determination can be made. A permit cannot be issued for the project until you receive a Letter of Approval from City Administration regarding its historic review.
72. First Name*
73. Last Name*
Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit Submit and Print

* indicates a required field