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Application <br />for - <br />�° Certificate of Appropriateness <br />t7 <br />W •c�c� <br />y �• � • •`.��. Historic Preservation Commission of South Bend & St. Joseph County <br />=� a 125 South Lafayette Boulevard <br />1865 Mailing address: 227 West Jefferson Blvd - 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 BOX <<< <<< OFFICE USEONLY <br />Date Received <br />2002 <br />Application Number. 2002 - <br />❑ NO <br />Past Reviews: ❑ YES (cu 10FL srl+anewl <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />❑ Local Landmark <br />❑ National Register District (T' 1: <br />❑ Local Historic District (rm.): <br />Certiilcate of Appropriateness: <br />❑ Denied <br />❑ Approved and issued <br />Title: <br />❑ National Landmark <br />❑ Tabled ❑ Sent To Committee <br />2002 <br />Address of Property for proposed work: 92 I t W, ln6t°iQaQ <br />��++ SneMMe -1w dStnnN- 0 <br />City : JOCXt 4 Qf, H4f Owner's Phone No: �± <br />Name of Property Owner(s):rrlutm 94. 1 WL�l� <br />Address of Property Owner: /3 Ct-[lt- — t 1, v ,BGU��di vt q <br />Contractor(s) Name: <br />/0//0//4 V � v J <br />Contract Company Name: NIA Contractor Address: / IA City: <br />Contractor's Phone No: /t' /,4 <br />Current Use of Building-, 1/0e- ,42aft <br />(Smsia Family - Muhi- Family - Commerdal - Government - industrial- Vae-nt - etc. <br />Type of Building Construction: 6h eK <br />(Wood Frame -Brick - Stone -Steil - Conaete- Other) <br />Proposed Work: ❑ Inkind aLandscape ❑ New ❑ Replacement(narin -kind) <br />(more rhan one box maybe checked) FT Demolition/ S4Z lj/aq� <br />Description of Proposed Work: /) 1�2<tt:d 0 � aSde4s F aW,,tr la2Q.-WOtGS <br />ma.".t see A*d. -,e q) , 'z) SQ /jVo of a: 4 i4z.eA 19- & use <br />7i' asSoer2> &"; <br />/ set&,O ;4S 0 � 4e �PSSr2i.u: Qce4� as� t, 76 X &,rWt;W . ' f) �tsrE. -a t�o� <br />,0 1W 9 (u SS SeeaQ 9 - aai� -rd- AdiLcK OrP yke" sih zi+ secl Ae - <br />si 0.1 <br />Owner /Contractor: Fax: e-mail: <br />(This o ffice will carnayond with only one designee) <br />(?Ay ?dZLWI C, Ok etlOY a( &/or <br />Signatu of Owner S' � (�' Signature of Contractor <br />APP�T N REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />