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nug 08 03 09:39a <br />06/05/2009 TUE 16:34 FAX <br />5742589984 <br />p.1 <br />1Q0n2. . , <br />Application 4 <br />- FOR <br />Certificate of Appropriateness <br />At <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette alvd., South Bend, tndiarui 46601 .� <br />Mailing Address: County -aty Building, Sout)t Send, Indiana 46601 <br />Phone_ ..574.2159798 Fur:574_235.9578 • Email: hlnodcornichiarmorg <br />Website: http : / /cojnmtuity.mkbiArLorgNstcrk/ <br />A Certified local CovemmeM <br />OFFICE USE ONLY » »> �(�o NOT COMPLETE ANY EIyM s CQ AI�ED t!V THLS AOX » >ss> OFFICE USE ONLY <br />Date Received <br />03 Application Number o— O 3 - 0'9-0 <br />PASI Reviews: E] YES (o rF&jre►rsrrba,) ;S�N O <br />Staff Approval authorised by: ? Title: <br />Historic Cornnd"lon Review Date <br />Local Landmark Local tlis[orie Diotriet (Woad 4 <br />[] National Landmark` [J National Register District Mann <br />Certificate of Appropriateness: <br />Denied [D Tabled 0 Senl To Committee [] Approved and Issued <br />�-- ss P D <br />Addre of Property for proposed work: I Ltr <br />Start Nrmkrand 5arret Nara <br />Name of Property Ownertsl: (Plate a.+ -:) 1 ` <br />Address of Property Owner(s): (3.) a L `1/ y f�C ST <br />Contractor(s) Name: v S / D -- •,S <br />Contract Company Namr. <br />CvntractorAddresc: c) — l - j L-/ r-/ic e - 14 ue <br />City: Phone; <br />Current Use of Building: <br />(Smglr Fmniiy - Mulri•Fanarly- C,naavn:iaf - Qwmrerraa - ledusrnaf - V.r•n! -rK•) <br />7= r2 / � <br />Type of Building Construction: u °L� c e l < < <br />(Wood Gnnq - tanct - Slenr - Sfa!- Concrrrr - OIArA <br />Proposed Work: 12'ln -kind 0 Landscape ❑ New [:1 Replacement (oar a'(•Iwad) 0 De+aolition <br />(,rfa.r 16 wr bar mry 6r c*cinO <br />Q <br />Description of Proposed Work: 1 Ep <br />1t; 1 �- DoV- d'I 1A1 ,- P t LC,a 5,4- rvl t S / ZL <br />S ,/ -/vk c 4 v t--,r/ ,., !F' /q r L - r - 5 r LrI <br />OwnwContracton Fax: ) S g C? I S - I t retail <br />(]hit om w4 m►m/o"! with asN ow dai rwr) 0�7 <br />and /or <br />Signature of Ourner Sign tvrr ojCnrraectcr <br />— APPUG77ON REQUIREMENTS ARE USTFD ON REVERSE SIDE — <br />