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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@michiana.org <br />- - - - A Certified Local Government <br />OFFICE USE ONLri»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN TIiIS BOX«««OFF/ICE USE ONLY <br />Date Received — 2 20 69-2— Application Number: 20qp_�%��02 <br />Past Reviews: ❑ YES (DArEOFUSTREWEn7 iXi NO <br />Staff Approval authorized by: &,-::P +/, �C .OL- .v<{�!�"%b iJTititlle': <br />U ✓ <br />Historic Commission Review Date: 2 2002- , Xe- /;i' -F Uf t <br />❑ Local Landmark ❑ National Landmark <br />❑ National Register District (x—.): <br />Local Historic District .): 7— <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued 20 <br />Address of Property for proposed work: / /,Z — 6/q Carroll i <br />Sden Namber and S—a Name) <br />City : So /J r,vrl 1'cv Owner's Phone No: 2 / ? 2 3 -t/ 3 0 3 �% <br />Name of Property Owner(s):lPRINr)._. V, fjl F,,.,,A <br />Address of Property Owner : 2 c7-7 W e L y4e 1 ( a H ,t 41hr L, <br />L !3A& rt7f-r��«1 S/� Sp, 4, �,W cii�o/ 70/ <br />Contractor(s) Name: �T�ta �4, /- <br />Contract <br />Contract Company Name: j34,g-sF , <br />Contractor Address: 13) b , n m i City: f:► 4 <br />Contractor's Phone No: 2 t h _23t/ — 30a <br />c /' <br />Current Use of Building: r't u I -f I I --ti.+. /a ( /amu i <br />(Single Family - Muhi-Family - Camnercid: &dMnn,ent- Industrial- Vacant - etc <br />Type of Building Construction: LV o oe <br />OVood Frame- Brick - Stone- Steel - Concrete - Othrr) <br />Proposed Work: ❑ Inkind ❑ Landscape JO New �a Replacement(nat;n-kind) <br />(more than one bas may be checked) <br />❑ Demolition <br />Description of Proposed Work: c�G g2„ R4,1 v., rs' , rc I�/�/ � f <br />6✓l�� r� hrlw, �-Z rP aJu l,.✓ s �t._.tp,/� ✓� Wo�l� It/=/ <br />�r7 S�-art 4uY /'vvf �„/ ,��/3 300- `� itplaccrin /'Ptii' Sires <br />Owner/Contractor: Fax: _21q 1 y —3d e-mail: <br />(This office will correspond with only one dengnee) <br />Signature of Ow/er Signatureof ontrector <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />