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11 <br />9. MAP <br />Please'Include a map showing the location of the property. A sketch map is <br />acceptable, but please note street and route numbers. Any outbuildings on <br />the property should also be noted. Please include a "North" arrow. <br />10. Is the property income producing ?, Yes No. X ; if so <br />will the applicant seek the Rehabilitation Tax Credit? <br />Yes No <br />11. Has the property ever been surveyed by the State Historic Preservation Office <br />or during a local historic building survey? If so, when and by whom? <br />January 1993 - Orange County Historic Resource Inventory, Todd Peck and Jody <br />Carter. File #ORO761 <br />12. APPLICANT OR CONTACT PERSON INFORMATION (If other than owner) <br />Name Orange County Historic Preservation Telephone 919- 732 -8181, ext. 2594 <br />Commission <br />Address 306 -F Revere Road <br />city /state Hillsborough, NC zip Code 27231 <br />Signature Date <br />13. This application is submitted (check one of the following]: <br />at the request of the owner. <br />X with the owner's knowledge but not at his or her request. <br />without the owner's knowledge. <br />Return to: Linda Harris Edmisten, National Register Coordinator <br />Survey and Planning Branch <br />State Historic Preservation office <br />N.C. Division of Archives and History <br />Xailsna <br />Address: 109 E. Jones Street <br />Raleigh, North Carolina 27601 -2807 <br />O.ftice <br />Location: Lewis -Smith House <br />515 N. Blount Street <br />Raleigh, North Carolina 27604 <br />Telephone: 919/733 - 6545 <br />