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Epplicati.on <br />- <br />FOR - �. <br />Certificate q Appropriateness a <br />Historic Preservation Commission of South Bend & St. Joseph County `oma <br />125 S. Lafayette Blvd., South Bend, Indiana 96601 <br />Mailing Address: Counw- ity Building, South Bend, Indiana 46601 <br />Phone~ d74-235-9798 - Faac 574-235-9573 - Email: his ncM=chiana org <br />Website: http://community ikhiarm-org/historic/ <br />A Certified Local Goveatment <br />OFFICE USE ONLY—»» DO NOT COMPLETE ANY ENfRLES = TA MT) IN THIS ROX »»» OFFICE USE ONLY <br />Date Received 09/-Z9/03 Application Numbera � ! - C -'Y <br />Past Reviews: M YES NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 10 <br />F1 Local Landmark Local Historic District Wamr) <br />M National Landmark n National Register District Wane) <br />Certificate of Appropriateness: <br />r7 Denied ❑ Tabled E] Sent To Committee Ej Approved and Issued <br />��ji DATE <br />Address of Property for proposed work: 16 o w"A Y IU F <br />itrw Number and Strrrt Nano <br />Name of Property Owner(s): (Please Print) C n !< <br />/ <br />Address of Property Owner(s): �`' f- t �'4 ui� '�x�- S 0 <br />Contractor(s) Mame: `�C � / + i- %� C0 C /,-\ <br />Contract Company Name: <br />Contractor Address: <br />City: t�L^ Vie'. ! ! FJ( J Phone: <br />Current Use of Building: �S%fv CLC-- i' rZ A,i ( L <br />{Singh Famcigt-Melt: Famtl� - Commrrcitl - Gatxrnmtrtt -Industrial - Varanl - e.c.) <br />Type of Building Construction: Ct <br />(Woad Frame - Sri k - Starr - Steel - Concrete - Other) <br />Proposed Work: F In-kind E]Landscape ❑ New [EI/Replacement (not imkira) C]Demolition <br />(morr than one irx may 1v rhrrked) <br />Description of Pmposed WorkY}') �.Z �!t,[ •LCL/'J �' 2!�+1� �`� i �l <br />lWa <br />t� <br />Owner/Contractor. Fax e-mail +/�"'� I t C t` � <br />Zhu ;ki1l'VnJraithT�,httZ_',/17 <br />drsagnre�. <br />/ and/or <br />j f Signature of {owner Signature of Contractor <br />f LAPPLICA'q NREQtIIREMF TS ARE LISTED ON REVERSE SIDE — / <br />j � 't G <br />CCT; <br />