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SEP -09-2003 10:24 WCS INDIANA OFFICE 5742877711 P.01i?;0 <br />M=hn t„ho= �i,ll, • <br />John Livingston (Attorney) <br />Catherine Hostetler Ururcr) jc= 5porleder (Architectural Historian) <br />t� <br />Contract Company Name: \Aj 1 (-l�r �Wg Tgmu Cq bd -- Rwt Le�7, l � <br />Contractor Address: 20 w • w Ast4 tQ - `:�j l'Te Z3 K-) <br />I rj AtAo ( Phone: rK7 7100 <br />Current Use of Building: <br />(Single Fancily — Multi -Family — Commercial — Govmmrnt — Industrial — Vacant - etc.) <br />Type of Building Construction: VUoOfl ��a�t�•-K /�����.i <br />(Wood Frame - Brick- Slone - $itel - Concrele -Other) <br />Proposed Work: ❑ In-kind ❑ Landscape ❑ New Replacement (not in-kind) ❑ Demolition <br />(more Own one bar may be checkrd) <br />Description of Proposed Work- R PL_4C�1?#jf" OF <br />�u►1.tt5IW61 i+J'�i�f-�lyclt� a� !✓! t�►I��r <br />W 1 N S)O w/9 IN 20, o00 5T=-_ ` WD - ZA-D" ADOMDQ . ��-6TbgKOZQ <br />OF:� AVDi-MeAVM N.1N wenr e-La/A110 J <br />Owner/Contractor: Fax: ZT7- _T7 11 e-g1ai1 �1 G�'r l`�-wtC� ✓l <br />(This office will mrmpand with only onr, des(pwe) <br />and/or ' <br />Signature of Owner ature of Contractor <br />-- APPLICATION REQ UMEMEN73 ARE MTED ON REVERSE SIDE <br />Post -It* Fax Note 7671 Date 9 ^ �9jip-091.. <br />#►a tio From\ <br />Ca./Depf, ' Co. ' <br />Phone/ Phone # <br />Fa: <br />