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002 <br />Application <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 Bend, Indiana 46601 <br />Phone: 574-235-9n8 • Fax:574235 -9578 • Email historic®michiwr org <br />Website: hRp: / /commwilty..niidVana.org /historic/ I. <br />A Certified Local Government <br />OFFICE USE ONLY » »» DO NOT ('0 - MELZ E ANY N B » »» <br />_ OFFICE tiss ONLY <br />Date Received U/�' /o q Application Numbefr p <br />� t — <br />Past Reviews: E] YES (t)atea /cast P,,4,,'a) ❑ NO <br />Staff Approval authorized by Title; <br />Historic Commission Review Date: L'L` r c�/ 2 oC ll <br />Local Landmark E] Local Historic District Qvamr) <br />[1 National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />Denied E] Tabled E] Sent To Committee [_� Approved and Issued r <br />DATE <br />Address of Property for proposed work: - 70 2 L a 6 Z I I ei <br />trert Num1w and Street Name <br />Name of Property Owner(s): (Please Print) �504-1 t H f:�? JFu l;7 eV, (7 Z4E, F t 2 j t, tV tT LYE GN 1 <br />• 2B'�- /GG6 <br />Address of Property Owner(s): �Q . W W. x �- G 7 <br />Contractor(s) Name , <br />Contract Company Name: <br />Contractor Address: <br />City: _Phone: <br />Current Use of Building: M" L - r J - J = tSrM 1 L-Y- .,� U u T 1 ! ' <br />(Single Family - Mulir Family - Commercial - Goorrnnunt - Indusdiai - Vacant - etc.) <br />Type of Building Construction: W6 d 62 JCAA F✓1 <br />(Word Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: KIn -kind Landscape [] New Replacement (not in - kind) g Demolition <br />(mare then one box may br c <br />Description of Proposed Work: _9E : 1 R <br />/VON fl/Ju�1 Sl/GTl( S�1l0/� E = LtJ JOG/. <br />r� C h [-A� Pe 2G,:( G.ve- u M <br />(A C-'a JV G'st L' V. 4U7 7 . - r M4 /x.) l�©z7iF <br />A:2512 A17OtL <br />OwnerlContractor. Fax: 2�1 - / - �i 7rS� e -mail J?ACCL 4 C44 : A-qg: , a Vitt <br />(this o l rrT7r5pon th only rnv ) <br />and /or <br />L <br />,11�`gnature of Signature of contractor <br />— APPLICA?TONREQUTREN ENISARE U TED ONREVERSE SIDE — <br />