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Application <br />for - <br />Certficate 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@niichiana.org <br />A Certified Local Government <br />OFFICE USE ONLY>»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS nOX<<<<<<OFFICE 1ISEONLY <br />Date Received <br />20 _ <br />Put Reviews:, ❑ YES (wrsaFLAvssnsw <br />Staff Approval authorized by. <br />Historic Commission Review Date: <br />❑ Local Landmark <br />❑ National Register District pt— 0 <br />❑ Local Hbtoric District p&.w: <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ Approved and issued <br />Address of Property for proposed work: <br />AppiicatIon Number. 2000 - <br />NO <br />Tltrx, <br />❑ National Landmark <br />❑ Tabled 11 Sent To Committee <br />20 <br />(W-50 1:7. k1�au ter_ Si. <br />surammbe r.fsrrrNagy) <br />City : StZt.Ifl. load_ Owner's Phone No:aY a 3N - `f 7p <br />Name of Property Owners):,TstNv M eA tit c.,j TCkl e,(- ('Iral v' 14.1, t <br />Address of Property Owner: S a. vtn P <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: i h SAX i C>Q Ll :�- <br />Contractor's Phone No: '!r 3& —7) q74 <br />J <br />City: AAJ mvS�u, e <br />Current Use of Building: ',::7,l o 1 t . <br />(SSinw�Fainity./!y(rt-Fami�ly�ommadot-Covanmrnt.ladurGial-Vocant- <br />Type of Building Construction:Py-KK-.,e <br />(wood Franc-$»&.Stars-Stesl-Conods- thhet) <br />off" li + foe <br />lot vxa1+n <br />5 � <br />�r <br />16400 _ K a.. S f, <br />IVA SZ� <br />A s$ — <br />"` a sba <br />Proposed Work: [Q Inkind ® Landscape ❑ New Replacement(nvi.-*indl <br />(r than ane box maybe cMexed) <br />Demolition <br />Description of Proposed Work: Ica. .g�� <br />Lx�.m•✓ r_ L4 t � <br />t c.�xC sc attA""k <br />-2) iv1��. �,vtvp-t„I '1'n uj.y?+uaej� ( V'71�vee...sa�rt. �= �c� ovac$ /'n,, Or Pig-)� <br />/i O <br />3� Q, -e. �v rr$kf �i qAwgt_ �j� �,Y ;w.� F <br />w 1or1CU'-`wou<. <br />WI%. a.rJ,+Atru- Ila K 9 t <br />Owner/Contractor: Fax: q�7—II ,S e-mail: i/ egklc . ick(4Pf_ 0 J <br />IaL .Cdvt-, <br />t1 _.m %Q consrpaad with only am dsriyneef <br />\44t C 1ck-gr-- <br />Signaturii ow- 4r Signature of Contractor <br />J APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />6) M6v. P-' VA -1 Sh—sf t A. cic to Gta_ . r ,.., n ..- va ni n • r ... w i5 h N.o ro •+n ,.. . <br />