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F O� .1:ll"111I;,I a - FOR - <br />�. Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />P a 125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />tabs Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone. 574-235-9798 • F=574-235-9578 • Email: historic@rnicNana.org <br />Website: http://commurAity.n-dcWana.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY »»» DO NOT COMPLETE A ENTRIES CONTAINED IN. THIS BOX »»» O£FICE USE ONLY <br />Date Received' q .2C4r13 Application Number2-0 0--3 - OSo <br />Past Reviews: n YES (o,a,o/r.nt x„i w) 'Sj'NO <br />Staff Approval authorized by: L'� _ii ,/'4 Title: <br />Historic Commission Review Date: "� Z3 - — - <br />0 Local Landmark Local Historic District (Name) 1'6 <br />0 National Landmark XNational Register District Wame) <br />Certificate of Appropriateness: / <br />Denied ❑ Tabled [] Sent To Committee 0 Approved and Issued <br />DATE <br />Address of Property for proposed work: I'qA PC.wasi e 2f _breve_ <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) i�11 z '*tA'¢_ <br />Address of Property Owner(s): <br />Contractors) Name:lr'kSuu <br />Contract Company Name: ':;G\'e (� \ L n CijAllc -f CSit iCet� <br />Contractor Address: <br />City: Phone: <br />- - -- Current Use of Building: �'^(C-4- <br />(i Sle Family — Muni -Family —Commercial —Government —Industrial — Vacant —etc.) <br />Type of Building Construction: �-+�C� ti c tt 11A ce'r. (t r ! C1U:U— 5' ieP' <br />( Wood Frame — Block — Stone — Steel —Concrete — Othd) Mme, <br />Proposed Work: F-1 In-kind ❑ Landscape NewReplacement (not in-kind) [3Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: tier ° 1_`40cl q_ SA /a 4"4 <br />` <br />Ct n - �t -i G.n !L—r`� � .� fi v� �x v� el . <br />LUrr ko'AJ Q alp -fin 'iz] c a ��. �-r �x ✓ if elS l <br />r <br />c� „ 1. � c�r1� �o�-.9n�..�..��'� � . ��� fG�✓10.`-/ w,� 1 c{a �� c.�'�r�,�. <br />0 i <br />OwnertContractor. Fax: e-mail <br />(Thisofficetvill correspond tvith only one designer) <br />-Cand/or <br />Signature of Owner Signature of Contractor <br />— APPUCA77ON REQUIREWENTS ARE LISTED ON REVERSE SIDE — <br />