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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 - South Bend IN 46601 -1830 <br />Phone: 219- 235 -9798 Fax: 219 - 235 -9578 e-mail: historic@micNana.org <br />A Certified Local Government <br />OFFICE USE O >DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX «« «OFFICE USEONLY <br />Date Received 'Y ( 200. Application Number. 204 O � ' <br />Past Reviews ❑ YES (curaortisrxansm ,NO <br />Staff Approval authorized by. Title: <br />Historic Commission Review Date: <br />❑ Local Landmark ❑ National Landmark <br />'gyp❑ National Register District pt..e). <br />yy <br />Local Mitotic District pw..J: <br />Certificate of Appropriateness: <br />Denied ❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued 20 <br />Address of Property for proposed work: 6 .3 r-) C A K oU <br />swrM..bswdi! rN q <br />5�J' - <br />City : Owner's Phone N I - .�.3� '��� L <br />Name of Property O wner( s):m"m x , O , �T lolllrm n--� <br />Address of Property Owner: nn <br />Contractor(s) Name :, aiao-, & <br />Contract Company Nam �J � <br />/ 01V djBz / / _ / <br />Contractor Address: Al I A C? /i/1. 44 4r 8 City �.�-G1 914-tZ <br />Contractor's Phone No: �' ab <br />Current Use of Building: <br />(Sintle Fe-dy- M.Ld- Fa�ni(r- C --ixl- Government -IMA'S & a!- Vaunt - eft <br />, <br />Type of Building Construction: <br />(lr0 . Brick-Stoae -Ste�C&" - OAer) <br />Proposed Work: ❑ Inkind ❑ Landscape ❑ New ❑ Replacement(..tin -kind) <br />(oast than one b= P be chocked) <br />❑ Demolition <br />Description of Proposed Work: �. <br />/Gf" �e • �l <br />er/ ft r: Fax: <br />TV o�iev lfk only one detlyne ) <br />, Signs re of Owner <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />e -mail: f(� <br />Signature of Contnct r <br />..1. <br />