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r <br />Application <br />:-for- <br />Certificate of Appropriateness <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 Fa:: 219-235-9578 e-mail: historic@michiana.org <br />A Certified Local Government <br />OFFICE USEONLp»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USEONLY <br />Date Received a% 2 7fl S— 7 Application Number. 20011- S/ 7 <br />Past Reviews: ❑ YES (Rlrr0FLlsrnE"E1N ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />❑ Local Landmark <br />❑ National Register District a4.w: <br />Local Historic District a&.w: <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ Approved and issued <br />❑ National Landmark <br />v <br />❑ Tabled ❑ Sent To Committee <br />20 <br />Address of Property for proposed work: /7.." z,. A�Id <br />� Sven MwbnwdSreNNa.e1 % <br />City: $fit;. I �. �.. Owner's Phone No: 8Sr ? <br />Name of Property Owner(s):iramv �%s'� <br />Address of Property Owner: /732 C. Gf a <br />I <br />Contractor(s) Name: e! >1oo;,O <br />Contract Company Name: C��"e.• �r .Gr �r J.�,�Qy,r. Lr..� . <br />Contractor Address: /3 d 3 City: <br />Contractor's Phone No: <br />ta�3 �,/ - 73 o y , <br />Current Use of Building: S, .0/i ,ry <br />(Single Fa''mjg- Hula -Family- Commeraal,Government - lndnaMal- Vacant -04 <br />// <br />Type of Building Construction: /�oae1 -:Rirrr M -r <br />(Woad Frame- Brick -Stone-Seel -Concrete- Otho) <br />Proposed Work: ❑ Inkind ❑. Landscape ❑ New ❑ Replacement(norin-hied) <br />(more than one box nny be dwded) <br />❑ Demolition <br />Description of Proposed Work: —,L w✓%uJ (/ r✓•f U' `/�'� <br />Owner/Contractor: Faz:�3y e-mail: G� w�.✓�aws � ao /, &.,a <br />(fhu office -11 vo rejpond with only am demgme) ` D - <br />I -— L. O=L—, <br />Sign of0 er jtl SignaturelrfContractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />