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Application RFCEry <br />-for- F� <br />Certificate o fAppropriaten&§ 2 9 p000 <br />Historic pre <br />Co s2 <br />n <br />Historic Preservation Commission of South Bend & St. Joseph County <br />227 West Jefferson Blvd - RM 1123 — South liend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 c -mail: historic@michiana.org <br />A Certified Local Goverment <br />OFFICE USE ONLY»»»DO NOT CODIPLETE ANY ENTRIES CONTAINIiD IN THIS QOX«««OFFICE USE ONLY <br />Date Received f6j od 20_ Application Number; 2000- oG2-4 <br />Past Reviews: ❑ YES (OAiEOF1d.177t1.rn-,in <br />Zoning Type: <br />Staff Approval authorized by: <br />Historic Commission Review Date: �llIO� <br />Local Landmark <br />National Register District (N—): <br />❑ Local Historic District lat.mel: <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ Approved and issued <br />Lot Size <br />AddreJss of Property for proposed work: <br />City :v ofTownshi <br />00 <br />Title: <br />❑ National Landmark <br />❑Tabled ❑ Sent To Committee <br />pt�S <br />20 dV�t/ i�;C�'1 hq <br />t- rnnm� <br />■ <br />MM44 a ti f-� <br />Name of Property Owner(s):(I.n,.v/)—Lt� /.r l _, ._ <br />Address of Property Owner:_ <br />Contractor(s) Name: <br />Contract Company Name: L/Gv,/ Ar l,/W <br />Contractor Address: Do. 800 `7 s � r Cily:Lel �"(� Q um <br />t�t��6� /3 3 , <br />Contractor's Phone No 0 Owtter ` 'n s Phone No: <br />Current Use of Building: %9111 G I/ <br />(Single £ainlly-AOdd-Family-Commercial. Government- ndustrlat- Vacant - etc. <br />Type of Building Construction: 11/,1%01 <br />(mood Frame - Britk - S1(,ne-Stld- Concrete- Other) <br />Proposed Work: ❑ Inkind ❑ Landscape ❑ New Replacement(aat/a-klad <br />(man than one hms may he checked <br />❑ Demolition (Completion of Seperte Form Also Required) <br />escnph n o ro osed Worl.: <br />Ak L ( RG t6zW ta/l/ 0, &U, 1r-Xd<Cr M,511 <br />Owner/Contractor: Fax: n e-mail: <br />raft Jl11 only one <br />.mr ; Signature of Contractor <br />L ATIO, I It UIR 1E TS ARE LISTED ON REVERSE SIDE. <br />Any and a hu si ss of thiA a j/ice is h ndled via e-mail and frt.v, with least preference to U.S. Mot! <br />