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Application <br />-for- <br />C rtificate of ApproprHateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />227 West Jefferson Blvd - South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic@michiana.org <br />A Certified Local Government <br />OFFICEUSEONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS nOX«««OFFICE USEONLY <br />Date Received Gf�? •mow 3 200-2 Application Number: 2011- O(561 T <br />Past Reviews: YESt cursu <br />oFsrREyie y NO <br />Staff Approval authorized by: {� Title: <br />Historic Commission Review Date: <br />❑ Local Landmark ❑ National Landmark <br />❑ National Register District (x—): <br />// ^ <br />ALocal <br />Historic District txa»J: <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued <br />20 <br />i <br />Address of Property for proposed work: 411 O p4s o, -e, Prive;, <br />soca nsma.r ad s:.0 xm.1 <br />City: 50vtt 1�7erlA Owner's Phone No: <br />Name of Property Owner(s):,vuA y Cob cMA Lucy J O Ylt1S <br />Address of Property Owner: 111 �G'r`4 ts�o r e r tve. <br />tncrehi <br />-Gc) N Pavia �- <br />es+t+wafer(t� Name: A <br />�5l7 <br />SAN <br />Contract Company Name: Av%, nl+eco 11Pavia <br />Contractor Address: 1315 E • W N"e c-1- City: S 0Aq B ev,d <br />Contractor's Phone No: U37- 715 `t <br />Current Use of Building: `aiYtiC. FAtn�► �ti( <br />{Single cmity-ttMata-F�svty-Commercial-Goverar»ut•twduuriat-Yreant-ue. <br />Type of Building Construction: W" A Fynnme. <br />(Wood Frame- Bric* -S(one -Steel -Concrete - Other) <br />Proposed Work: ❑ Inkind ❑ Landscape © New ❑ Replacement(narin-Ai-d) <br />(more than one bos may be checked) <br />n_ -Demolition II (� <br />Description of Proposed Work: 760 S. � • C,ttlgtTt ovt +'a <br />hov5 i -i o Vrovtje, tiev 1`='r ;100r kl�4�Gv% l 2t - IOOr- <br />b.edYoom . vJ inn A*y vba-& 1410,5CS. <br />Owner/Contractor: Fax: 2.67-7465 e-mail: AaV1�`-xtS6�tn0 � Gmeri�ec�.V1G� <br />(Thr. office -11 cwrerpond nith oaty one designee) <br />Signature of Owner i afu o Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />ltx <br />