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Q001 <br />Application <br />�a ` <br />FOR - <br />,� Certificate Of Appropriateness <br />Hrstoric Preservation Commission of South Bend dr St Joseph County <br />• `e 125 & Lafayette Blvd_, South Bend, Wiam 46WI <br />Mailing Address: County -City Buildin& nth Bend, Indiana "I <br />Phone: 574-235-4798 • Pax57'.-233-9573 + Finaii his�hiattia org <br />Websitet http;//cornmtuik.rrddiWu.org/histmk/ <br />A Certified Local Government <br />OFFICE USE ONLY »>»> DO NOT COMP FrE iNY Eh HjFS ret -VN Mr) r_V MM BOX »»» OFFICE USE ONLY <br />Date Received;t aoo 3 Application NumberA 0'0 r!1'3 <br />Past Reviews: p YES 4wrcfta9Reom) p No <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />Local Landmark 0 Local Historic District (Name) <br />National Landmark [] National Register District Q:amrtl <br />Certificate of Appropriateness: <br />E]Denied Q Tabled M Sent To Committee 0 Approved and Issued <br />DATE <br />Address of Property for proposed work: 10L# K. hMW_._!5t• C'3 -M'5 <br />Stmt N►•tnber and Strut Name <br />Name of Property 0wner(s): (please Prini)-;Soo t4 47AIdo-W1JG <br />Address of Property owner(s): a �G . �t� fF Ettsa�,i � .5>00 r &AiQ!1,-j <br />Contractors) Name: 15 V_' k? N�C"G kAky <br />Contract Company Name. C -A - -1 t'" Wt x1154 <br />Contractor Address: A-44.14, ' -J !?,, <br />City: �c1'�i , nit, —11d Phone: ZR( -0k-750 <br />Current Use of13ui)ding:tAt-- <br />(Sm3le Fammil/�y- Multi -Family - Commercial - Coaernmen: - fndustrial - Vacant- <br />Type of Building Construction: CST EIL <br />(Wood Frvmme — Br U- — Srcnt - Stews — Concrete — 04*r) <br />Proposed Work: ❑ in-kind ❑ Landscape P4Naw ❑ Replacement (.not in -nod) M Demolltton <br />(mart tlar. arx Ara may be ducked) <br />Description of Proposed Work: t A LL &e 7E '..t? A#Jr> 14.5 -MI I <br />At -m%P,4t,eA"fata4 ttE -rjH- F:P, ?" <br />W(40b"3 g 3p (&hb -MO Z LbteJ6,, <br />Owner/Contracton F., -[ l'Q-752- e-mail <br />(This office :.ti1 wrmpvmd ruilh only one desrift) <br />and/or <br />Signature of Ou-ner signaturtof ontractor' <br />— APPI.ICAT70N REQLUREMENTS ARE US7W ON REVERS SME -- <br />