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Application - for - Certificate of Appropriateness Historic Preservation Commission of South Bend & St. Joseph County 125 South Lafayette Boulevard Mailing address: 227 West Jefferson Blvd - South Bend IN 46641-1830 Phone: 219-235-9798 Fax: 219-235-9578 e-mail: Wstoric@niicWana.org A Certified Local Government OFFICE USE ONLY»»»IXI NOT COMPLETE ANY ENTRIKS CONTAINKn IN THIS BOX«««OFFICE USEONLY Date Received C' 2 S 2002 Application Number: 2442- 0'7-2-S Past Reviews: YES (zuraortwsraav�am f*!'ry!Ny9� t " NO Staff Approval authorized by* Title: Historic Commission Review Date: �d -` /2A:X-?- ❑ Local Landmark ❑ National Landmark ❑ National Register District.J: yfj �rL 0 Local Historic District d Certificate of Appropriateness: ❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued 2002 Address of Property for proposed work:142 A4-:'1- sre« hr.k-r .r sera IJ.wd City: !;AL L2) Owner's Phone No: 2 9?�- /��2 6 l Name of Property Owners):irluNv Address of Property Owner: IDA 4'1L)1f?- 9'77, At / i JQ•� c Contractor(s) Name: Contract Company Name: Contractor Address: cri�� it��61�' /�l�!ci��rGr�tttlttXitc�t' E Contractor's Phone No:.S��%_ — r Current Use of Building:11 M (Sinrk 'ly•Hald-Family• a« 'al-Gavernnunt-lndueMal-Vicente eta Type of Building Construction: 4- t6 (Wo,od Frame - Briea -Stone -Steel - Concrete- Other) Proposed Work: ❑ Inkind ❑ Landscape 1_I New • ❑ Replacementmatrn ti~d) (mora than ane bout may be checked) ❑ Ttta:trliti^^. Description of Proposed Work: _Lip . 1P Q 1. Owner/Contractor: Fax: S'y= C3 41 -12 e-mail: :2 �,9 �txos �s?.lSI. exi (This office will cormspowd *Ith only on* deaynes) _�o r &!or Signature of Owner Signature tractor APPLIt:ATION REQUIREMENTS ARE LISTED ON REVERSE SIDE.