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Application <br />-for- <br />Certificate. <br />for - <br />Certi icate. 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: historicgiNnichiana.org <br />A Certified Local Government <br />OFFICEUSE ONI"Y»»»DO NOT CONIP1•F.TE ANY ENTRIES CONTAINED INTins n0\«««OFHCE U.SEONLY <br />Date Received / — -.Z V 20Q? Application Number: 200 Cl ` __ <br />Past Reviews: A(YES (DAMOFIAMEVIEa) X c,Jr / . 2 z ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />Local Landmark ,EI National) Landmark <br />National Register District (N-1): <br />❑ Local Historic District (NNae): ll <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued <br />2002 <br />Address of Property for proposed work- IT] (" of jy, IY1 <br />�� sr/.NNwwe./aeSreNNaeu) <br />City:-'l-�G-�� '11U' Owner's Phone No: �� I{ — cj `t 17 (4-1 <br />Name of Property Owner(s):(rR 1 <br />INTI �11 t l low P�;L�U_)o iI <br />Address of Property Owner: � 7 Dt_!illl <br />Contractor(s) Name: W i 11 la tyl ( 4li <br />Contract Company Name: -e.4 �; -13 ()41e r -Elti IJe <br />Contractor Address: 0 c� Q N IDurf1 K d' City: Tr. -IJ <br />Contractor's Phone No: <br />Current Use of Building: m vl�h A m r ly <br />(Single Family - ATMA -Family - C•ammacialt Government - lndadrial - 1 scant - dG <br />Type of Building Construction:( <br />(Woad Frame - H," - St-- Sud - Concrete - Other) <br />Proposed Work: ❑ ].kindLandscape New ElReplacement( aria-Aind) <br />(more than one box may be chrctedl <br />Demolition l lrcId'k <br />I.l,r <br />Description of Proposed Work: t/� II K.C� �1U 1VI�t.S `r�`�- Clit.GL t-CA�fCll't <br />pPrmll'-hon o�T trLojd- 1-,('eau<y if i Pl�r..�Ifr�itt�� <br />Ood ni opl-6 2�C rt_tj�-inrl ry)000V d1,16 b lam, dr-, <br />I'vi vC T0*Dhf4'rZr 0a1,,. P0_ # 14 1,5 (' - da,06 _�ro bb '' dl , rkicc <br />Owner/Contractor: Fax: Ll e-mail: a -mail: Exiti�'t�'V�'��(r`� t%2. wo, Cl�l"►J <br />(Thuoffin tall rorreryond-th/only o�do,S-,) <br />Signature of Ownery Signature of Contractor <br />APPLICATION REQ UIREMENTS.ARE LISTED ON REVERSE SIDE. <br />