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-.IAN 2 'I 2020 HISTORIC PRESERVATION COMMISSION OF SOUTH BEND AND ST. JOSEPH COUNTY County-City Building, South Bend, IN 46601
<br />htlp://www.southbendin.gov/goverrunent/departmcnt/community-investment
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<br />IHG�/ Phone: 574/235.9371 Fax: 574/235.9021
<br />Email: hpcsbsjc@southbendin.gov
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<br />Michele Gclfman. President A Certified Local Government of the National Parle. Seivicc Elicia Feasel, Historic Preservation
<br />Administrator
<br />APPLICATION FOR A-CERTIFTC TE OF APPROPRIATENESS
<br />OFFICE USE ONLY»»»DO OT COMPLETE A y ENTIUES CONTA[N_ED lN nn. 'BOX«<«<OFFICE USE ONLY
<br />Date Received: ( /-z7 f �z.o Application Number:
<br />Past Reviews: D YES (Date of Last Review) __________ _□NO
<br />Staff Approval auth orized by: ______________________ Title: _________ _
<br />Historic Preservation Commission Review Date: -�--�--�-�_::_-.-\--__ (c _____________________ _ 0 Local LandmarkD National Landmark
<br />Certificate Of App�ri11teness: LJ Denied □Tabled
<br />Address of Property for (Jroposed work:
<br />[] Local Historic District (Name) _______________ _D National Register District (Name) ______________ _
<br />D Sent To Committee D Approved and issued: ________
<br />(Street N11111ber-Slreet Name--City----.Zip)
<br />Name of Property Owner(s): Av""' 1 � L.L-C Phone#: ________ _
<br />Address of Property Owner(s): 3 A h 0 "Z...J-+ fu_,{ s+ --r �l-A VI \I ' i S-rO-e I b '5' I 4 3 0 '2..
<br />(.';;treet N11111ber----Street Name---'.City---Zip)
<br />Name of Contractor(s): -�R�1_c.._· o..._r_J.�'(:)��,J_ii!..._' �-,,,,�0-��_e..:_,._ __________ Phone#: ( $' 14 ) U� 8 5' ZS
<br />Contractor Company Name: J2, ±0 ·s L nve.s-f n-i e."'{S ll(
<br />Address ofContractorCompany: Zl t3 r1,sh ,iuJa._)Lo... A�-5:,ui-h ()e,"'o{ z,J 4�61."i
<br />(Street Number-Street Name-City-Zip)
<br />Current Use of Building:
<br />h1//i-Fa111ily--Co111mercial-Government-lnd11strial-Vacant-etc.)
<br />Ty(le of Building Construction: -----------------------------------
<br />Proposed Work: (more than one
<br />box may be checked)
<br />(Wood Fra111e-Brick-Stone---Steel-Concrete-Othe1� D Landscape D New D Replacement (not in-kind) D Demolition
<br />Description of Proposed Work: :fo..jl c, off �oc-4� we-'>t 6,')..c,.\l e"'{r'f door-_, ·(!_ � o....,..J re.-el�c..4!...
<br />u;,t�. wo,DQ S1d'""':, .• Cbo.---'3-e.. Vl"'lf' )l.,tc..\.,,.Q..Y\ w, ... JovJ Q-�o�·+he 5,V\IL. I i:<:l...lle_ ot<:"bo.e..\L e---t,� doo.,.. .,-v..d cepLo.....c.e. "1� s.J,q)_,V\,g fo..·+.o cfooii ()....,...J. kz.J lo/ &
<br />__ L jµ.-:)aJ.. Je..c..\l ,0 1 2<: 8 1 w, '--:;+1,,$ J:e�ll..,rc,ls tl.;e.. 1-,,'.}--c..l<' b( 0-,;-J.. t ,x \;>;l..se, ...... .e."'f �?,,-tc.� e,(TCf'IOr Q.V\-t<"',' J,oor,fA-0...l�e,.. \T fv "'""0""-0..' o.,..,._--;/50-f""--f:or vse-...L Owner e-mail: J ,fos 1 "'v TY\",. vi ts >YJ-i.r l.('.O'll!ind/or Contractor e-mail: d.. ,f o 5 1 ""veJ 4.,...., e...., \5 YV'I 0--• ( • c..o'"""
<br />and/or X ��-�,,:;���==/t/2=e=v:=�==="t..======------Signature of Contractor
<br />By signing this application I agree to abide by all locnl regulations rcla1cd lo project and to oblain a Building Department Permit, if applicable
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