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118/2tt/21111:► 'I'IIP. 14:15 IrAt <br />Applicadnn <br />FOR <br />Cert&ate of Appropriateness <br />Ulstoric Preeervatlon Commission of South Hand & SL Joseph Cowl <br />•. 125 S. LabycM Mvd• South limb lndIam 46MI , <br />\?ailing Addma County Or/ building. South BWA, Ind= UX1 <br />Phme:57I M 9745 • Faa 574 M 9578 • rmaMhleteeW0m1dV=atg <br />Webeilt ittt�//Gon1t 1WlilylrtidltAnaAtb`/Nsoortc/ <br />ACnt:fnilraalMyrm ent <br />UJ otil <br />OFFTCE USE ONLY•••••• DO 1407 COMPLETEAWEN=5 CO AM= Mtn= ffcrx" .,• OFFtCE LME ONLY <br />DeteRwtiveA $Z� <br />-�-23 Applieet,enNuntber___:_-_:'._..... . <br />PASIRtvlewft nYES(rWrrertanamrm) nNO <br />Staff Approval authortzad by. Title <br />11)Atnrir Cnmmtcslorr Re.Iew 0.11- <br />i ural Landmark I Coal Hlotodc District owr) <br />❑ NAHAnat ranAmIrk Narinnat it.cter► Ta W44 (N—) <br />Cerdfleale of ApproprWecssr <br />Uenied ❑'I-ablyd []5n+t•Ih l'armmttee Approved and hatted <br />f� <br />DATE <br />Addeo, al Pmp.M for rmpoped—ort-: (OSI PuVwLSiA"p. -ov—. <br />SIrM N.mMIAlblhn IJrwr <br />Mine of Property 0wnerls} (pima Prier) <br />Address ofProp.nyOwnerb)e fort P-IUr.R-51 1• '09— <br />Contaetor(s) Nana _. T �01��. <br />Contract Compmy Name. — _-_-. _._...-_--•-- .... <br />ContaftrAddrem; �� NiSc�►awa�. �u2. <br />city. 3,4 L <br />Cumcnt Use of building, Si MGM F"t -, <br />(51flj1r FLwny _ Wftf-FAmq - Coeoenmr► • rAermeef.7MrtcnlY+vnrnr- nc) <br />TypcofTWIdingl_'onstruehon, (1,)00b FILOHL <br />(4.d <br />prupuaed Work: Kiln -kind U Lanclseape XNtw E]Replacement (mi A Imre) ❑ Demolition <br />Desaiptlon of Proposed Woriu _ - <br />�sT�u. �-Si1�- fbj�p.ooh{ WtNQoW oN <br />S-7-coN'A i=Lov R,z I ND -TW c) Sk4 U&tRj ON <br />SuC4¢- � Wt3� j o NOT l���.11L�e <br />Owner/Cunlraclur. Pr• <br />631 a*C-St z email p� u0. P—btj <br />()t:aCC9 Twarmrm?we+A�wNmw/r(?m) <br />�".',,t —_',d�"`� and/or <br />Slgnare orE tMmu Sipsture of Coetncter <br />— APMCA710MREOMMWFN7SARE US= ONRAWSSWE <br />