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Application -for- Certificate of Appropriateness Historic Preservation Commission of South Bend & St. Joseph County 125 South Lafayette Boulevard Mailing address: 227 West Jefferson Blvd - South Bend IN 46601-1830 Phone: 219-235-9798 Fax: 219-235-9578. e-mail: historic@michiana.org A Certified Local Government OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY Date Received 7— 9 2002 Application Number: 2002- 0-709' Past Reviews: ❑ ,YES (DATEOFLAS7REVIE"' ❑ NO Staff Approval authorized by: Title: Historic Commission Review Date: ❑ Local Landmark ❑National Landmark ❑ National Register District 1Na a ): Local Historic District (Nam,): Certificate of Appropriateness: ❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued 2002 Address of Property for proposed work: % 0 � 7 M 12-slb tZ �fc. /'SrnerNanbc andSrnnNa,n� City I/ 7/-t � `�� nOwner's Phone No:� � �✓r %{�_ Name of Property Owner(s):,rmNn fes( 0 /'114-N Address of Property Owner: I D 6 % R I l l Pz S(b 6/2 Contractor(s) Name: S'CU V 9 L G r� M Contract Company Name: <<C�\/`(C� Contractor Address: vZo23 % 7��/LJS 21J City: Contractor's Phone No: a % ) — q,�-W G } Current Use of Building: .. .. (Single Family - btuLd-Family - Commercial - Go—mad - Industrial- Vacant - etc Type of Building Construction: (Wand Frame - Brick -Stone - Sted - Concete - Other) Proposed Work: ❑ Inkind ❑ Landscape ❑ New ❑ Replacement(nat;n-kind) (more than me boz may be checked) ❑ Demolition Description of Proposed Work: C �N<< iLhlGtE I=T - 1 -FI t.-Gt KI 7 T�flS i l /('1 rz • J— ' lri0 e/ L hi j— t l,<—fi t o /Li�46t 1 T I T, C 1414 I N N 1 �C �' r,- /-j C, F Lr--l7-1-f SL67rzS .F TyIS 1S oe0 -7D71,-idLfz b0i,IN p4kT or. 71fz :., F 4c-fz- 7a lS 17'l2U/ I-% F' -/ TUI C,tft 1 N- �(/Yl< S GC O er/Contracto Fax: e-mail: �ffice will coespondi my one designee) rl Wor ignature of Owner // Signature of Contractor APPLIVCATION REQUIREMENTS ARE LISTED ON REVERSE SIDE.