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k A% <br />Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend k St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Add--:r----r; Building, South Bend, Indiana 46601 <br />Phone: 574-235.9798 • Fax: 574-235-9578 • Email: historic@niichiana.org <br />Website: http://communitymichiana.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 6' - 30 =<?Cr3 Application Number:2 O O 1 - 0 C3C' <br />Past Reviews: F1 YES (Date ofLost Pteoiew) F1 NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date - <br />Local LandmarkLocal Historic District (Name)a�f'r�� <br />National Landmark C] National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied E] Tabled [] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: do S &p-Y►.1r_- <br />1 Street Number and Street Name <br />Name of Property Owner(s): (Please Print) 71 tA er ZNA4* <br />Address of Property Owner(s): i 1 oR • wsLY►J� s� Sev'F"� 8E-�-�� <br />Contractors) Name: <br />Contract Company Name: t4A -L- -4C,,11r CaJQMJC�riib� . U!f <br />Contractor Address: 1S(,4S Et,+90C—S Pj. <br />City: IVIiS�P+aA-tl-P- Phone: 571! 2cj1.9Slg <br />Current Use of Building: StJ 6L-,-- �a.� t <br />(Single Family — Multi-Famrfy — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: 4-�ecs� ��e•- J _5>&A-� &Z"_ V=.j <br />(Wood Frame — Brick — Stone — Steri — Concrete — Other) <br />Proposed Work: []In-kind EZLandscape gLNew ( Replacement (not in-kind) fRDemolition <br />(more than one box may be checked) M%_jdl oc� ;7 <br />I 7 �I I Ir <br />ejLr- <br />Description of Proposed Work: �0�1 ear �Ir IS- x 18- 6 <br />C;:' 9.0�- oJAr"cJ MF- CSL ts.r,-.4s- lZ ric. 5-3 To MX10 2.0.#A r <br />giT'�.Yso � b.' tit C o _ r �.L M .1 v G�•..� J.Szs t o..li y. <br />10 �-i 2rx�� lei 4 CA ' CAI) STu� C 1d • _49 i S. S1 <br />it-f�-s j T •�- °.J t s.0� ?2. �i'.�-�'� P -...b: -e 9. <br />Owner/Contractor. Fax: X74 1-2 SS- so -2-1 e -ma' tySL'P 4 2-(ZAat-_ <br />L• <br />(This office mill correspond:oith only one sigmer) <br />and/or ° <br />Signature of Owner 6r - ignature of C tractor <br />— APPLICA77ONREEQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />