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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 . ; 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 /> 12 . APPLICANT OR CONTACT PERSON INFORMATION ( If other than owner ) <br /> Name Telephone <br /> Address <br /> City / State Zip Code <br /> Signature Date <br /> 13 . This application is submitted [ check one of the following ) : <br /> (at the Aquest of, the owner . <br /> with the owner ' s knowledge but not at his or her requesto <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 /> Mailing <br /> Address : 109 E . Jones Street <br /> Raleigh , North Carolina 27601 - 2807 <br /> Office <br /> Location : Lewis - Smith House <br /> 515 N . Blount Street <br /> Raleigh , North Carolina 27604 <br /> Telephone : 919 [ 7334� 6545 = <br />