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�4 <br />Application <br />-for- <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 South Lafayette Boulevard <br />Mailing address: 227 West Jefferson Blvd - South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail. historic@micWana.org <br />A Certified Local Government <br />OFFICE USE ONLri»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOXa«__OFFICE USEONLY <br />---7--5- <br />Date Received /2002 Application Number. 2002- G 7L.S <br />Past Reviews: ❑ YES (ou-EaFt,s7REnrs9 ❑ NO <br />Stats Approval authorized by: Title: <br />Historic Commission Review Date: <br />❑ Local Landmark <br />❑ National Register District (mm.): <br />XLocai Historic District (x_). <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ National Landmark <br />❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued 2002 <br />Address of Property &17 <br />jr}�or proposed work: j � . V GZ V Xf,City: _C's[ ,l y� Cr Owner's Phone No: / 5 � <br />Name of PropertyOwner(s):mx,Nn 1✓&t lor,lL/ jj i"-• Z( /'t01Cr 711,D j / ` <br />Address of Property Owner : 5 1 I�UQ '�l?(' G G� /Gt ! 7(-,11a L I Vj `�� �i j.✓ <br />Contractor(s) Name: t l� , f �Q (C' r A c v S h <br />Contract Company Name: Ma ��' r n c Lv S,k , �,S �" �C; eve r -/ /lGt <br /><: <br />Contractor Address: �` I (xtP /�( City: V-' t rR e e k` <br />Contractor's Phone No: <br />Current Use of Building: <br />(Sinlie f'a/nuAW&F—1y-Commercwl-Gov�wv-lndusmai- D'acanr-ec <br />Type of Building Construction: /�'/� / c <br />(Weal Frame -Bnek- Stone -Steel -cmn ere -Gtherl <br />Proposed Work: ❑ Inkind l=1 Landscape ❑ New ❑ Replacement(noti -kind) <br />(mon than one box may be chedked) <br />❑ Demolition ( <br />Description of Proposed Work: )) I /7l (' t;f e t? /j�% S Ull.S�' i21 Qll)1 F <br />�ffC'S (��%/iYG1Cll1?Ct f!IG �� T 1�1�/1 C7°�Ct r'eA rttt-�j <br />J <br />e/Contractor: Fax: MY 1 2 33 - 9G'Uq e-mail: <br />kis o e nU rnrsespond wnh oo,* oonnnee dw g e)f, <br />4!6 <br />Signature of Owner Signature of Contractor <br />/ <br />J APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />