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Application <br />- for - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 South Lafayette Boulevard <br />Mailing 4ddress: 227 West Jefferson Blvd - South Bend Iti 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic,t_imichiana.org <br />A Certified Local Government <br />OFFICE USEONLY>> »>DO NOT COMPLETE ANY ENTRIES CONTAINED IN TI[IS HOX«««OFFICE USE ONLY <br />Date Received 7—_9 2002 Application Number: 2002- =3 <br />Past Reviews: I YES (D.trEOF[ASTREviEm ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: <br />❑ Local Landmark <br />❑ National Register District a;_o <br />Local Historic District ny e): , <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ Approved and issued <br />❑ National Landmark <br />Address of Property for proposed work: <br />Tabled Sent To Committee <br />2002 <br />' SNen hSwer ind Srra Ntroe) <br />City (I <br />Owner's Phone No: <br />^? 3 3 - <br />7-D —T <br />Name of Property Owner(S):^wn <br />/ it i1v V e n P `� <br />� ' a�u � <br />Ce C <br />Address of Property Owner: Ajy-YZ 0 _ <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: City: <br />Contractor's Phone No: <br />Current Use of Building: O �Grl + .i vl iii 3rd t ,-iDU'+: C Q <br />(Single Famdy-MwIt M—1y-CoMMrram-GovernMew-I.dean,*-Vacant-eta <br />" i (''(i'J <br />Type of Building Construction: W -00(.1W-00(.1- 4-116i 'C_._ i5k2,i VLtt <br />(Woad Frdme- 8nak . StoneC—ete- GM-) <br />Proposed Work: ❑ Inkind ❑ Landscape ❑ New Replacement(nat;n-rind) <br />(Mort than one box may be checked) <br />❑ Demolition <br />Description o`f Proposed Work: + � 1 CGl `� 60 U1 0 - 1 u `p�Om <br />RA k f S t� ! C/ttrt (+-2 1� i C' i T <br />- <br />CY��r� -fin <br />O�wn�er/Contractor: Fax: e-mail: <br />?hiee(fi�et wia cormpond Mdrwdy, onedenggee i <br />_�:.•Cil.,�i1.-J1.,,1(�u...x.-wc.r.�.;d'ti�s�/��c(Or <br />Signature ofOwner \ / - Signature of Contractor <br />APPLICATION REQVMEMENTS ARE LISTED ON REVERSE SIDE. <br />C'C�Cun17//I g to sb e -A 5 <br />