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Application <br />-for- <br />., Certs- iicate ofAppropriateness <br />¢ Historic Preservation Commission of South Bend & St. Joseph County <br />227 Wed Jeffi=scu Blvd - South Rend IN 46601-1830 <br />Phohe: 219-233-9798 V.-= 219«,2.33 4578 a -mail: historrtci Ma <br />A Certified Local Government <br />20 <br />Plat Reviews: ❑ YEs Gaetaor�wtrRsrmro <br />Staff Approval autbarized by: <br />Historic Commission Review Dae,.: <br />❑ Local Lanam.rk <br />❑ Natimw ReVMW Diarw air <br />❑ Local =&$*Vic District or-" <br />Certiticate or Appropri.teaess: <br />❑ ponied <br />Application Number_ 2000- <br />❑ Na <br />❑ National 7 --dmark <br />❑ TabW ❑ Soot To Commlttao <br />❑ Apploved and Issued 2Q <br />Address of Property for proposed work: <br />Citi, A%iG , os owner's Yhon 1'do:� <br />Name/of Property owners):�rRnvr� / > �' jjKY,I' - j <br />Address of Property owner <br />Contractor(s) Name.'- <br />Contract Company Name:_, ,, <br />Contractor Address: City - <br />Contractor's Phone No: rte, <br />Current Use of Building- <br />le�x�wr(�-�iwOmrri.t(y-eaiaiwad°'�` aar.wnln�t-rM4raiat- vae,owr-ere, <br />Type, of Building Construction: V' <br />Proposed Work: ❑ Inkiad ❑ Landscape ❑ New LJ Repltteemeati5••+�-+z••c► <br />l..wre w,. a!!! ecae �.ae aroretrua/ ❑ <br />Demolition <br />Description of Proposed Work: 7I�i <br />Owner/Contractor: 1xat: e-mail: <br />�9 »rrt p,,.,c�p-,ud wttls..rty alit.tautt+wJ ,. <br />$ifr,IIat4rMt of owner% 8ignaturo of 4wacractoir, t <br />APPLICAT,yox RRQUMZMENTS ARE LLSTED ON BEVE%2SE SIDE. <br />a <br />Too@i 8Yd ST:LT KOK Z0oZ19Z/C0 <br />