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Application <br />-for- <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />227 West Jefferson Blvd - RM 1123 — South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic@michiana.org <br />A Certified Local Government <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS ROX«««OFFICE USE ONLY <br />Date Received 20 _!�t Application Number: 2001; Q_W <br />Past Reviews: ❑ YES (DATEOFLASTREVIEMJ ❑ NO <br />Zoning Type: <br />Lot Size <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />3/11/q <br />❑ Local Landmark <br />❑ <br />National Register District (Na—):rR <br />J <br />Local Historic District Mme): V`� <br />Certificate of Appropriateness: <br />❑ Denied <br />�] Approved and issued <br />j( <br />Title: <br />❑ National Landmark ' <br />❑ Tabled <br />200k <br />❑ Sent To Committee <br />Address of Property for proposed work: i It �) r.) e vJcte ST, <br />Sneer Na berand&i No ) j est <br />City: Youth eett-oc- Township: � <br />Name of Property Owner(s):(FktNn_ r ��tt rJal eiitd %UCt vi ua _Ck,te,(_ <br />Address of Property Owner: Sat.ws0_ •J <br />Contractor(s) Name: M i ke AA n vi n <br />Contract Company Name: M S� <br />. I',. A4,2 h Yl r, -)in 511 , a C;b n in <br />Contractor Address: 14R kevlbd>,, A.-2, City: Pr klteyv�— <br />Contractor's Phone No: o� 3 -6-1Q --� Owner's Phone No: 02 3 q — 019 2 - <br />Current <br />Current Use of Building:, 11k,51.O_ 431,"11(4 l,_OVVI .e— <br />(Sing! amity-MuU4FFamily- a <br />ercial-Government-industrial-Vacant-et <br />Type of Building Construction: Wood "o / tiu c -(%o <br />(Wood Frame -$rick -Stone-Steel - Concrete - Other) <br />Proposed Work: ❑ Inkind ❑ Landscape ❑ New ® Replacement(notin-kind) <br />(more than one box may be checked) <br />Demolition (Comoletion of Senerate Form Also Reauired) <br />Description of Proposed Work: Sof (ct r2 dE�P.✓i Q►a �e.i �I r.'t vn n <br />MA n d r•- brg, 11, i t! y e s <br />l S eJ50 a t t"11n 0 C( t A- fl) 0/111-11 <31 A fkg rN K. -r � �otc�l � h) <br />coww,,--la-kLeyr J P" Af,,, a— t-1 <br />11) aovi wteo�F . <br />Owner/Contractor: Fax: Al 7 —11 v'kc; e-mail: + (a t J , cc*,,., <br />(nibs ie will cor_responrd/Xwit1 h. onl�y one desig-nKet))c <br />Signt <br />e o ner Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />Any and all business of this office is handled via e-mail and fax; with least preference to U.S. Mail <br />