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F APPLICATION FOR CERTIFICATE OF APPROPRIATENgSS HISTORIC PRESERVATION COMMISSION OF SOUTH BEND AND ST. JOSEPH COUNTY ROOM 1123 COUNTY -CITY BLDG. SOUTH BEND, IN 46601 (219) 235-9798 e: 7 - Owner's Name: Mailing Address .40 *X 1117._' of Owner //Z 414W y Designation:J7• Telephone: �Z—%ffiZ I DESCRIPTION OF PROJECT: Proposed demolition of this duplex. Structural and rot damage, as will as foundation deterioration. (Structural and rot damage most obvious on the back of the structure.) Excessive disrepair of wood siding, roofing and gutters, porches and steps. Examine feasibility of in -fill housing. [] Continuation Sheet [] Addendum to Certificate The following information as applicable to the particular situation and the standards designated shall also be submitted as part of this application: I Structural drawings and specificationp, or site plan, floor plans, elevations, crops section plans, renderings, diagrams, or other such plans., specifications. Where the proposed project includes a sign, a scale drawing showing the location of the sign'on the structure or property, the type of lettering, and the method of illumination. other such information as the Historic Preservation Commission may require under the provisions of the Zoning Ordinance of the City of South Bend or the St. Joseph County Zoning Ordinance, as applicable. The filing of this application shall be accompanied by a fee of three dollars ($3.00), payable to the Historic Preservation Commission to cover the costs incurred in reviewing and processing this application. H, I signature Applicant's Printed Name J FOR OFF)CE-USE�ONL1( COMPLETED APPLICATION RECEIVED (date):CASE REVIEW AND DECISION OF THE HISTORIC PRESERVATION COMMISSION In-kind Replacement Continuation Sheet [] Appropriate [] Addendum [] Denied [] Partial Approval [] Inappropriate Date: I Historic Preservation Commission. ,I Notice to Aaalicant: Approval of your application and issuance of a Certificate of Appropriateness in no way signifies compliance with health, safety or general building/zoning standards. Neither does it release or relieve you from compliance with all codes and regulations of the City of South Bend, St. Joseph County, or the State of Indiana. The commission ex- pressly disclaims any liability resulting from safety or health defects in any structure for which a Certificate of Appropriateness has been issued. Approval of your For projects not application expires six months from the DECISION date. substantially completed, contgict HPC for renewals.