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Application <br />°yylSSlphr• <br />for. <br />o ph IttC/ <br />Certificate of Appropriateness <br />2 <br />Historic Preservation Commission of South Bend & SL Joseph County <br />ass 227 West Jefferson Blvd - RM 1123 - South Bend IN 46601-1830 <br />Phone: 219-235.9798 Fox: 219-235-9578 e-mail: historic@michiana.org <br />A Certified Local Government <br />OFFICEftseo bY» 6MRILICOMAINr.D IN Tltlt ROA— c<OFF/CE USEONLr <br />Dote Received % 20,0/ - Application Number. 200,11- D 517'6 % ' <br />post Reviews; DYES (rurrausr In , ❑ NO <br />Zoatal Type: toot Stu <br />StaftApproval authertttd byl Title: <br />Historic Comadsd" Review Date: <br />❑ Lasal Laadaazk - ❑ National Landmark <br />❑ Nadeaat Reakttr Dktdct ev.. J. <br />❑ J.4111stork District . <br />Certificate ofAppropriateness; <br />11 Dnkd ❑ Tabled ❑ Stat To Committee <br />❑ Appreved ad imaed 2d_ <br />Address of Property for proposed work: S/o t� t!/U, <br />r..Ir..r.:Jb.. <br />City : o &ZD Township: <br />Name of Property Owner(s):mnm,-s /� <br />Address of Property Owner: �7/n /r" ,P',-�� Q,a r' <br />Contractor(:)Name: '/rld�- (�_T✓,» <br />i T <br />Contract Company Name: '/f�/lQ%rt r_ i/ �Y2JrS�iJ�in J <br />Contractor Address: —.93 <br />Contractor's Phone No: Owner's Phone No: <br />Current Use Of Building - <br />FS -01 +NtT'Crwawe!✓'GewnMeew-Ahm M-Yecwr.ae <br />Type of Building Construction:.- 62 //jst <br />OY Fnwe. drka-(rwr..GM+Cworw•ph <br />Proposed Work., Inkind D Landscape D New Z Reptacementr..lt•-at•n <br />prn la•e wr ar.wr k t+wa•4 <br />Demolition (Vemulellon efSenente Form Also Prouirtdl <br />Description of Proposed Work: <br />Owner/Contractor. Fax:�d 7 lia.�i a -mail: <br />troa�dtnytaanaa.•t.sewy e.trip..y <br />r A <br />SlaaotarootOwaer g nroo 'oa nctor�` . <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />day and all baslaess of this office Is handled via e-taall and fax, with least preference to U.S Mail <br />