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Application <br />—FOR— <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend do SL Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 * Fax: 574-235-9578 • "Email: historicOnidhiana.org <br />Website: http://communitymichiana.org/historic/ <br />A Certified Local Govenunent <br />OFFICE USE ONLY >>>>2-> DO NOT COMPLETE ANY MIES CONTAINED IN THIS BOX>: »> OFFICE USE ONLY <br />Date Received.7� <br />p7J Application Number 2_0 3 0(p O9 <br />Past Reviews: [3 YES (oatroftnst Rergew) <br />Staff Approval authorized by: <br />■ • <br />Title: <br />Historic Commission Review Date: ilio �1�1 f} <br />Local Landmark Local Historic District (Name) rAsr \tt AYH5 <br />National Landmark National Register District Wame) <br />Certificate of Appropriateness: <br />Denied [ Tabled 0 Sent To Committee ❑ Approved and Issued <br />PATE <br />Address of Property for proposed work:33,E EAS t' V%1�/nf% C-�+r� `��`� <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) _TIM AhA 1P14-4 Y -1 a n es <br />Address of Property Owner(s): �?-�' -ar AS"f''V�%Mn 2'►�- ty"�h <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City! Phone: <br />Current Use of Building: S t�{ r'Ar l <br />-Govrnment-Industria!-Yocant-tta}Fingleamily-Multi-Fa y -Commercial <br />Type of Building Construction: W rtA Fv-Ame, ^ El,-,rie k <br />(Wood Frame — Brick — Stone — Steil — Concrete — Other) <br />Proposed Work: ❑ In-kind ❑ Landscape 1a New f—I Replacement (not in-kind) % Demolition <br />(mon than one tax may be checked) (f t <br />Description of Proposed Work: 0& ARAe- P� 4 L-f- <br />4agir <br />hii-F- 1lt/iltti►nn tz.Lvtnnie, Psi ��►: 2aS.��' <br />Owner/Contractor. Fax: e-mail <br />(This ojWwill comsl»nd uith only one designee) <br />and/or <br />irate of Owner Signature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />