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Application <br />- <br />for- <br />Certificate <br />or- <br />Cert f cate 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 Fax: 219-235-9578 e-mail: historic@tnicWana.org <br />A Certified Local Government <br />OFFJCEUSEONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICEVSEONLY <br />Date Received 3 — 20 01 Application Number: 200$- 0J11 <br />Past Reviews: ❑ YES (DArzoFLAsrAEnEWI /9NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />❑ Local Landmark ❑ National Landmark <br />❑A <br />(tom. � <br />National Register District : <br />Local Historic District <br />Certificate of Appropriateness: ' <br />❑ Denied ❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued 20 <br />Address of Property for proposed work:i a- I i\ el � L Gv C P <br />,,1 j SrnrtMu.bw SteaNa+W <br />city: (: }I) x"4'1 � Q T\A Owner's Phone No: �(�� - 53� ��4q <br />a <br />Name of Property Owner(S):(FRiNn (� 1`u to h Y1 �� Ca t164 M <br />Address of Property Owner: �-a1q <br />Contractor(s) Name:�',na r`� `G 5 A� nl 1 lick <br />Contract Company Name-'- }6. <br />. i <br />Contractor Address: QajjuQa 1 Ii -SO) ) 't C1 City: Lxr,pr I _ <br />Contractor's Phone No: rso, L�69' CM - V(aLs t <br />Current Use of Building: <br />(Sinyk Family-Nr7a-Fa�nity-Cawrnerda!•Gov¢nment-Jndurtriot-Yacant-eta <br />Type of Building Construction: 1 o n ft cA \RG yyi R <br />and Frame- Brut - Stone -Steel - Concrete- Other) <br />Proposed Work: ❑ Inkind ❑ Landscape ❑ New . ❑ Replacement(.atan-ki d) <br />(mon than one box maybe checked) <br />❑ w <br />Demolition <br />Description of Proposed Work: �P P I G C.Q. <br />ceP,cwQ PtacieS Grid 5o`pv,%+3 <br />Owner/Contractor: Fa:: e-mail: <br />(rW office wdl correspond »th only o.e drnsnee) <br />9210=14 34 e k <br />Sigaatum of O nerh Signature of Contractor a f NA,%I <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />