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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 address: 227 West Jefferson Blvd - South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic@tnichiana.org <br />A Certified Local Government <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received —�� 2002 Application Number. 2002- 0%// <br />Past Reviews:r ❑ YES (DATEOFL9STREl?EWl ❑ NO <br />StaffApproval authorized by: <br />Title: <br />Historic Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />❑ National Register District (x—,): <br />Local Historic District (Nam,): <br />O <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued <br />2002 <br />i <br />Address of Property for proposed work: 13?joZ Eti5� Wk—lV{c S+' <br />Srn � Number o+d So-eer NaneJ ' <br />City : �QJj-IA 13c�d Owner's Phone No: 25x`1 <br />Name of Property Owner(s):rFRINn < ��f. z 4���t/ ` K+ 1�7 �✓i � <br />Address of Property Owner At, A1+nJc <br />Contractor(s) Name: 3J_A,., VA,d A,41 <br />Contract Company Name: SD�,� �_/o✓ol C��,r✓cf��l <br />Contractor Address: -) r; 9 clS e_, 12' 2 City: �o�tln i3c� d <br />Contractor's Phone No: a 3 2 — a012 <br />Current_UseofBuilding: <br />(Single Family - Nulti-Family = Coentnerdal- Govaement-Industrial - Vacant -etc.. <br />Type of Building Construction: W, o fir. w,c ¢ ! -+q4 P <br />(Wood Frame - Brick -Stone -Steel - Con�ete�Otha) <br />Proposed Work: ❑ Inkind ❑ Landscape ElE New Keplacement(norin-kind) <br />(more than one box may be checked) . <br />❑ Demolition <br />Description of Proposed Work: P, rP j, drrvcwvy - <br />./1�✓\NCP J -'✓)4 [I c�+ 1-,/,�O�oW i.✓cIIS 1/ <br />TO fryl.cc ���-,►�)Id �,,✓/�„f wc11c C71,rs Is »ot vrsr6l� �'�+ S�rz�cf� <br />Owner/Contractor: Fax: /1 e-mail: <br />(This office will cor pond ml only one dengneeJ <br />�� &/or <br />Signature of Own Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />