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Town of West Seneca Historic Commission West Seneca Town Hall 1250 Union Road West Seneca, New York 14224 HISTORIC HISTORICCOMMISSION COMMISSIONLANDMARK APPLICATION DEMOLITION REVIEW GENERAL INFORMATION & CONTACT FORM GENERAL INFORMATION & CONTACT FORM Assessment Address : _________________________________________________________________________ 919 Mill Road Property Owner : _____________________________________________________________________________ Town of West Seneca Owner Mailing Address : _______________________________________________________________________ 1250 Union Road, West Seneca, NY 14224 Year(s) of Construction : _________________________ 1843-1855 Architect / Builder : __________________________ Unknown / Ebenezer Society Original / Current Use : __________________________ Residence Architectural Style : _________________________ Period of Significance : _________________________________________________________________________ 1843 -1855 ( Moved 1957 ) Is the property eligible for or listed on the National Register of Historic Places ? ( Circle One ) Undetermined / Not Eligible / Eligible / Listed Has the property been documented in any historic resource survey ? If yes, include the documentation with this application. ( Circle One ) Yes / No / Unknown Is the property owner aware of this landmark application ? If No or Unknown, please provide evidence of contact / awareness efforts. ( Circle One ) Yes / No / Unknown Is the property owner in favor of this landmark application ? If yes, and applicant isn’t owner, please include signed statement of support ( Circle One ) Yes / No / Unknown Application Fee : A $250 50 application fee is required upon submission. If applicant is proposed landmark owner, this fee does not apply. Applicant : __________________________________________________________________________________ Mailing Address : _____________________________________________________________________________ Phone : ________________________________________ E-mail : _____________________________________ Signature : ______________________________________ Date: _______________________________________