Daglish Precinct LHS nomination form

1. About me

First name and surname

* required

Maximum 100 characters

0/100

Your address

* required

Maximum 150 characters

0/150

Your suburb

* required

Select option

Your email address

* required

Contact phone number (optional)

Maximum 20 characters

0/20

Please enter number without spaces.

2. Your nomination

The place being nominated can be a building, group of buildings, an archaeological site, garden, man-made park, a tree or group of trees

Name of place being nominated (if any)

Maximum 150 characters

0/150

Address of place being nominated

* required

Maximum 150 characters

0/150

For a heritage area nomination include the boundaries of the heritage area, for example: Nos 3 to 21 and Nos 4 to 28 Jones Street, Subiaco.

Current owner (if known)

Maximum 150 characters

0/150

It is not compulsory to inform the owner before submitting your nomination, this can be followed up by the City when reviewing the nominations.

10.

If you are not the owner, is the owner aware of this nomination?

Yes

It is not compulsory to inform the owner before submitting your nomination, this can be followed up by the City when reviewing the nominations.

11.

Please provide a physical description of the place you are nominating. If known, please include information on the construction date, original owner or other owners, and the original designer and builder.

(dot points encouraged)

12.

Can you provide an image of the place you are nominating? If yes, please upload image here.

Please keep your image file size to less than 5MB. Formats accepted include jpg / jpeg, gif, png, bmp, pdfs and word documents.

13.

In your opinion, how does this place relate to the history of the City of Subiaco?

* required

(dot points encouraged)

14.

Please tick at least one of the following criteria for the place you are nominating.

* required

Aesthetic value - an architectural style, and/or particular aesthetic characteristics such as scale, composition, materials, texture and colour that have value to the City of Subiaco.

Historical value - associated with a particular person, event or activity.

Scientific value - provides evidence of past activity or demonstrates technical innovation or achievement.

Social or spiritual value - associated with a community or cultural group for social, cultural, educational or spiritual reasons.

15.

Do you have any other comments or points to note, for example references or heritage listings, about this place?

Thank you for completing this nomination form. Please hit submit when ready.