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Applica4fl <br />- FOR — <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd, South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Pend, Indiana 46601 <br />Phone: 574-235-9798 • F=574-235-9578 • Email: historic@n-d hiana.org <br />Website: http://commurdty.michiana.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 9 ` /q - 03 Application Number .2 —0-0 3 • O'9' I y' .4 f <br />Past Reviews: C] YES NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />Local Landmark gLoeal Historic District (Name) <br />National Landmark 0 National Register District (Name) <br />Certificate of Appropriateness: <br />n Denied []Tabled E] Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: f o 7 AJa f7-il45;t (i b r2 . <br />nN/t <br />Street <br />rNumber and Street Name <br />Name of Property Owner(s): (Please Print) <br />M fh� 4 A -T fflblYTS 1 t'�NT {EAlfil+tl <br />Q !` <br />Address of Property Owners}: tD? NQ�TitSrta,x�* ' �u"' t � j •'i/'l Sjo ; <br />LA d'u/Avr,4, C,4 4 2 2 S <br />Contractor(s) Name: �^' C-'`{Y'fS <br />Contract Company Name: <br />Contractor Address: i q 2-3 ^ r. <br />City: Al I Imo -R . _'N 465-q5- Phone: S7`t- 255- "74,71 <br />Current Use of Building: /`✓-"/3�7/� Y <br />(Single Family -Mulfi-Family-Commercial -Government - industrial- Vacant -etc.) <br />Type of Building Construction: l,t. eeo r-2ho(g— <br />(Wood Frame- Brick - Stone - Steel -Concrete - Other) <br />Proposed Work: E] In-kindLandscape 'F' New E] Replacement (not in-kind) 0 Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: _7NSi AL -L OPP-1 vAoY AjaZ7?4 do <br />dr= f�Qovaruv t r2t t�VIArJ t E7�lGiC4' Y 1Au5TAGLSU IN TNz� h'D'i. (.�}t}c.L <br />(,U't t. -L- CbA, Ai Vc4` T -o �d-�1 S/ [) CVL} -LLS. RF +1 o1v,'•_ k-4 e L ea. <br />/3)js7 Sf�E� firms i s2iii )6.0 Lvrt, X,6� 14zDa�-n 7-e r1r3©.?i.4gc <br />�214A-r,.4 .l- 1 C=Ca /L A7T� 5 <br />O e /Contractor: Fax: e-mail <br />iso n wilt corres�and wit only onId, <br />} <br />� and/ord�7 ��" "� •Ul. <br />Sigma re of Owner Signature of Contractor <br />// — APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE -- <br />