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' '-Ii'• PF.AC <br />-�.;..- <br />11;/G� <br />OCT 2 9 2019 <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County-City Building, South Bend, IN 46601 <br />http://www.southbendin.gov/government/department/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov <br />Michele Gelfman, President A Certified Local Government of the National Park Service Elicia Feasel, Historic Preservation <br />Administrator APPLICATION FOR A-CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONL Y->»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX<«<«OFFICE USE ONLY <br />Date Received: _______ _ Application Number: <br />Past Reviews: □ YES (Date of Last Review) __________ _ □ NO <br />Staff Approval authorized by: ______________________ Title: __________ <br />Historic Preservation Commission Review Date: -----------------------------□Local Landmark D Local Historic District (Name) _______________ _D National Landmark D National Register District (Name) ______________ _ <br />Certificate Of Appp!.l!.riateness: LJ Denied □ Tabled D Sent To Com mittee D Approved and issued: _______ _ <br />Address of Property for proposed work: 163 2, 1634, 1636 Lincolnway West <br />(Street Number-Street Name-City-Zip) <br />Name of Property Ow ner(s): _J_a_s_o_n_M_i_ll_e_r ______________ Phone#: <br />Address.of Property Owner(s): PO Box 462 Mishawaka, IN 46546 <br />(Street Number-Street Name-City-Zip) <br />Phone#: <br />5748491307 <br />Name of Contractor(s): ---------------------------------- <br />Contractor Company Name: <br />Address of Contractor Company:----------------------------------(Street Number-Street Name-City-Zip) <br />Current Use of Building: <br />-Govem111e11t-!,1d11stritil-Vacant-etc.) <br />Type of Building Construction: ----------------------------------- <br />Proposed Work: (more than one <br />box may be checked) <br />(Wood Frame-Brick-Stone-Steel-Concrete-Other) D Landscape D New D Replacement (not in-kind) D Demolition <br />Description of Proposed Work: Rubber roofing repair, b,riok li�ai:P, <br />bbib..;ll, eaA <br />c:tC ltdtJc,,flf Wortcfl e �;f.."'aad/or Contractor e-mail: <br />and/or X ___________________ _ Signature of Contractor <br />By signing this application I ab'Tee to abide by all local regulations related to project and to obtain a Building Department Permit, if applicable. <br />-APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE- <br />10/30/19 2019 1030 <br />Elicia Feasel, Historic Preservation Administrator <br />x <br />x 2019-1030