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Application <br />- for - <br />Certfflieate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />227 West Jefferson Blvd - South Bend IN 4660I-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 c -mail: historic@tnichiana.org <br />A Certified Local Government <br />OFFICE USF: 0N1.Y»»»n0 N(yr (*o%tPI.F.TF ANY F;N'rRIF:S CONTAINED IN THIS n01'«««OFFICE USEONLY <br />Date Received % i &-, 20 a7 Z /j Application Number: 20Q- 52/1P <br />Past Reviews: YES (cur[ofWTAEt•tEw7GGt, I 111`/%Jr ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 1 `�2 &- --Z6 -.- <br />❑ Local Landmark <br />�(❑ National Register District (N-): <br />Local Historic District (Nam ): <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ Approved and issued <br />❑ National Landmark <br />❑ Tabled ❑ Sent To Committee <br />20 <br />Address of Property for proposed work: 101 Litt 4Px0- <br />City: <br />- <br />City: Owner's Phone No: o2;� r%-- '�Q 0 y <br />Name of Property Owner(s):(rRiAT) 0" /, e I e Y <br />Address of Property Owner :_16171 4a14L,, 7, .fid tl_7� <br />Contractor(s) Name: cot arse. �C.r <br />Contract Company Name:`(oep" �ht a t? <br />Contractor Address: oL s&n A?ottd City: of 2Ltd <br />Contractor's Phone No: ;?,`1 X1-15- Y'7 <br />Current Use of Building: �,;J4 -(-�_ uyr rk r <br />1/'-Uidti-Faraify-(Pinmercia(-Government.Industrial-Vacant-etc. <br />Type of Building Construction: Wdd{I qu4n p <br />(Wood Fiume- Brick - Stone - Steel - Conade - Other) <br />Proposed Work: Inkind ❑ Landscape ❑ New ❑ Replacement(notin-kind) <br />(mart than one box may be checked) <br />❑ Demolition <br />Description of Proposed Work:'7yYl�l QL J� ''UI LO&I PC s <br />y ( <br />a 51rta 61 �ioug"p- �hew <br />Owner/Contractor: Fax: a -mail: Sh r_to r i* /0 1,1.&n <br />(This office wit correspond with only one designeeeej)� � �„ (/ <br />4.�LG/Lb"'�it..�+ ; ..Gi-.tom <br />Signature of Owner Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />