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Application <br />for. <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 South Lafayette Boulevard <br />Mailing address: 227 West Jcffersotl Blvd - South Bend IN 46601-1830 <br />Phone: 219.235-9798 Fix: 219-235-9578 e-mail:ldstoric@n� chiana.org <br />Certified Local Government <br />OFFICE USE O1NLY»>»>DO NOT COMPLETE <br />ANY ENTRIFS CONTAINED IN THIS HOX«-«� «OFFICE USEONLY <br />Datelteeeived S `f..7 2& <br />AppllcatlonNumber. 20Q? -0 J/5— <br />Put Reviews: -. ❑ YES (aM0?IAtruY7re9 <br />NO <br />StatfApproval authorised by <br />rt V 7we 4 <br />Historic Commission Iteikw'Daox. • . ,. . <br />,: •, ::x,.:- .. �.til�trn ��''++��t trr!±n! ttMnmrsi" *n a.,..r:...+�..�« <br />_;. <br />t_J Local Landmark <br />National Landmark <br />❑ Natlonal Reghter District w-th <br />❑'IAM Hl. oricDistrict <br />Certificate of Appropriateness::.. <br />❑ Denied.• .• i <br />❑ Tabled ❑ Sent To Committee <br />❑ ApPmved and Issued <br />2002 <br />Address of Property for proposed work: <br />. SnrNrYer a�eSrerNrwy - <br />City : Owner's Phbne No: 70t -3G f=610 V Ch <br />(-boa-36'7-3u- <br />40246 <br />Name of Property Owner(s):rruvo e i k.l a- A I^ 4C 1)urltl <br />Address of Property Owner: 101 0 -7 W -04+P C_V+ �-i tl`t . , � � per, L 64 <br />t - _ <br />Contractor (s)Name: _ ��a. 40-1/i•G <br />Contract Company Name: r �'1• <br />Contractor Address: W/, 2 s/' City: 5 • �/� <br />--- - - - - _ Contractor's Phone No.,Ul--0353-- - - - - — -- - - - -- ---- <br />Current Use of Building: 5! t a <br />• • . (�Nr enoly • Nrfo-nnFon�ifj-CMnmeruel • Geranmenf •lwdaebir' • Veeent- ee. u V <br />Type of Building Construction: 1. r.T Tr'&,,� <br />(n'aodMienu-Mck•Si me.&M• C"awe• oan) <br />Proposed Work: Inkind ❑ Landscape ❑ New ❑ Replacement(nar:nawn,0 <br />(nam Una ane box may be cMcked) <br />❑ Demolition <br />Description of Proposed Work: (2> visa• i p-,, © il.-krLe� 6 -vi- — 6ev, •.fie <br />t.� 6Qx" Cd a � ; 0 <br />-� �w - rte- 4. <br />� <br />ra`t�",ti a'"., �i�-c• It:4 aL - Y,�lo�.uti..,.t� , t,J+� Q L .y,ti,, c+�t �L t V >, G� <br />W,J;.t�-•..q, t.�•.!-e•t..•, Q�w. %K F„0..,,.��..r � �'�t s��-V'c•e <br />Owner Contactor: Tax: 7 E4 -36 / - lY 6 3 e-mail: 1J 0 i 1 r r ao �. L41N► <br />(All go lw MIt CD/mJ)ald Mall arty one duijneeJ J v <br />&/or <br />Signat5re of Owner Signature of Contractor <br />APPLICATION QUIREMENTS ARE LISTED ON REVERSE SIDE. <br />