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Application <br />-for- <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 South Lafayette Boulevard <br />Mailing address: 227 West Jefferson Blvd - South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic@michiana.org <br />A Certified Local Government <br />OFF/CEUSEONLY»»»I>D NOT COMPLETE ANV ENTRIES CONTAINED IN THIS nOX«««OFFICE USE ONLY <br />Date Received 1 2 S 2002 Application Number. 2002- 0'7-2-S <br />Past Reviews: Z YES (ruraggFusTREviEry � �'' J ry^❑ NO <br />,G.IG�� .c� «rt`�.2ccG6w its6� <br />- Staff Approval aathoTlzcd by: Title: <br />Historic Commission Review Date: /d — /% <br />❑ Local Landmark ❑ National Landmark <br />❑ National Register District (N..q: <br />Local Historic District nom-): <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee <br />❑ Approved and Issued 2002 <br />Address of Property for proposed work:1,27 !°�/��i/i�C-��i' <br />S+vee Nvaker .J Sree Name) <br />City : S ob t r� Owner's Phone No: <br />Name of Property Owner(s):mmyv <br />Address of Property Owner :__LL / ;'QQ� �i4�nn /DA 4-A/ )A7_ 9 <br />Contractor(s) Name: S�l.Q.Ait/wte'U'/�l <br />Contract Company Name: <br />Contractor Address:10�,- <br />Contractor's Phone No:.%--/ <br />Current Use of Building: _ <br />(Sint4 'y -m -Governnent-lndutrial• Vacant -ata <br />Type of Building Construction:_--",,—�-Fkdya.al-d- Q191i <br />(Wood Franc- BWci - Simi--• Steel -Concrete- Other) <br />Proposed Work: ❑ Inkind ❑ Landscape ffNew ❑ Replacement(narin-hid) <br />(mon than one lax may be checked) <br />Description of Proposed Work: � /AA UtA, <br />Owner/Contractor: Fax: al�y_ C) e-mail: -7" <br />(Thio office <br />ewilljmrnrpond wllh only one desynee) <br />LG &/or <br />Signature of Owner Signature Co tractor <br />APPLICATION REQUIREMEN'T'S ARE LISTED ON REVERSE SIDE. <br />