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Application <br />- for - <br />Certi .Cate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 South Lafayette Boulevard <br />Mailing address: 227 West Jeffersori 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 />OFF/CEUSEONLYy»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USEONLY <br />Date Received s'— oZ / 2002 <br />Past Reviews: ❑ YES (DATE orrwsrMVIS 9 <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />49 Local Landmark <br />❑ National Register District (x.-): <br />Local Historic District (No..). <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ Approved and issued <br />Application Number: 2002- 6 -S�2 <br />❑ NO <br />Title: <br />❑ National Landmark <br />❑ Tabled <br />2002 <br />❑ Sent To Committee <br />Address of Property for proposed work:.7��i 1GYQ� <br />SrnaMwMrw/S <br />City : !�%� Owner's Phone No: <br />Name of Property Owner(s):rrjuNv_/ ,0,V S 2xjC, / lj/II/f//r �(G1cs�' 740,41 5aly—e� <br />Address of Property Owner: , -V%4 <br />Contractor(s) Name: <br />Contract Company Name: C� <br />Contractor Address: _City: <br />Contractor's Phone No: <br />Current Use of Building:�U <br />(SinPlrF.mar.aralo•F.,Niy.connuraal.cov�inrn�.redum;.l.vane.ea - <br />Type of Building Construction: <br />(fv Fr. -Brick -Stupe-sted.cmade.Other) <br />Proposed Work. Inkind El Landscape ❑ New ,J Replacement(notin kiq <br />(more Than ow hoz may ',hocked) ❑ <br />Demolition <br />Description of Proposed Work: Avw2_/ <br />Owner ontractor: Fa::�����D�QIp���- <br />ri rex do r) <br />&/or <br />Sign ure tOw er Signature otContractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />