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Application <br />— FOR — <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />725 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: Count), ity Building, South Bend, Indiana 46601 <br />Phone: 574- 2359798 • I=574- 2359578 a Email: historic@rnicNi .org <br />Websitehttp: / /communi". chiana,org /historic/ <br />A Certified Local Government <br />OFFICE USE ONLY »» » DO NOT COMPL ANy EMMjrc "D PY TPIC BOX »>»> OFFICE USE ONLY <br />Date Received ��—���- -ZO0.3 Application Number O 0_3. 0 <br />Past Reviews: E] YES (P.tea/Lne Bn nr) pCl NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review D ...,,,___ at ,,, e ((( : 1 �- �/' _'2e-c <br />E] Local Landmark Local Historic District (N r2dCiC.ri <br />National Landmark National Register District Waose) <br />Certificate of Appropriateness: <br />Denied ❑ Tabled ❑ Sent To Committee [-] Approved and Issued _ <br />• (� / f ^ / I DATE <br />Address of Property for proposed work: <br />ryry1 stree Number <br />ber and Seet N, a <br />Name of Property Owner(s): (Please Print) II Ir Al. o.n6� 1r,�f,,. , , � 1 • f, k <br />Address of Property Owner(s): SC. W\ L <br />Contractor(s) Name: rn,I�f_ V' e, <br />t J <br />Contract Company Name. u F I I V r Ar p <br />Contractor Address: ??,Iq�r I Q,A t, <br />City: S7 ��h ']ev -!'l� W06 lX Phone: C 2.17.'17/ <br />Current Use of Building: nr� <br />(Smglr Flmdy -�f tulti- Family - Ca�emu ov rammt - Industrial l -C - Vacant - <br />t � etc) <br />T <br />Type of Building Construction: L � <br />( Wand From, - Bnek - Stan, - Steel - Concert, - Other) <br />Proposed Work: In -kind F] Landscape [2r<ew E] Replacement (not,n.k:nd) [] Demolition <br />(man than onr tar maa t,, <hgW) <br />i 1 \ p <br />Description of Proposed Work: 15' olu��,n uw. 2oi', �,• -kc n:r ,, 4)- k <br />1 � <br />rl,u,I I, \i _G.,, ) <br />Owner /Contractor. Fag: <br />(The o/jee o,f mrnpard oath only a,v dnignm) <br />��CUS Flnn'T <br />e aaT <br />e-mail / ♦�.a� <br />and /Or <br />Signature of Owner Signature of Contractor <br />— APPLICATION REQU /REW&VIS ARE LISTED ON REVERSE SIDE — <br />