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Application r <br /> y�urH 6E -for- a`o�MisslohFgr <br /> Certificate of Appropriateness <br /> 'S• ;ter\'��.�"�,_ >; a S <br /> Historic Preservation Commission of South Bend&St.Joseph County <br /> 1865 227 Nest Jefferson Blvd-South Bend IN 46601-1830 <br /> Phone:219-235-9798 Fax:219-235-9578 e-mail:historicgmichiana.org <br /> A Certified Local Government <br /> OFFICE USE ONLY—­>D0 NOT COMPLETE ANY ENTRIES CONTAINED IN THIS OOC«««OFFICE USE ONLY <br /> Date Received 20 4"/ Application Number: 200 0tF-4 3 �� <br /> Past Reviews: YES (DATEOFL4STREvlEM7 -2 3- L PntL NO <br /> StsCArpro:")-ut!lorh,e•f by.7�� � >�T�N Ti:lc: I?Re"r-a oZ�1V <br /> Historic Commission Review Date: <br /> ❑ Local Landmark ❑ National Landmark <br /> ❑ National Register District(x-,): <br /> XLocalHi3toric <br /> District <br /> Certificate of Appropriateness: <br /> ❑ Denied ❑Tabled ❑ Sent To Committee <br /> ❑Approved and issued 20 <br /> ,12-71 <br /> Address of Property for proposed work: *?,? !V. ISD�'fh `jhC re pr• <br /> sr,,,,vamb,r ands>«,,vam<f <br /> City: D Owner's Phone No: �3,�--79- /7- <br /> 70 <br /> Name of Property Owner(s):P.ar.sr, dA-V12_q1U( �_4 <br /> Address of Property Owner <br /> Contractor(s)Name: <br /> Contract Company Name: `--- <br /> Contractor Address: City: <br /> Contractor's Phone No: rr l <br /> Current Use of Building: �t 1-� 1 IL <br /> (Single Family-Mufti-Family-Commercial-Gavernment- ndumia(-Vacant-etc. J - <br /> Type of Building Construction: .lr)>/ty/t — <br /> (WoodFrame-Brick-Stone-Steel-C'oncrere.Oth f <br /> Proposed Work: ❑ Inkind 5L andscape ❑ New ❑ Replacement(natin-kind) <br /> (mare than one bar may be checked) <br /> ❑ Demolit/io - L- <br /> Description of Proposed Work: <br /> Ctrr-eo�5r`S , C�oGJ1 in hz�,�a�7- flthucr� 40Cj-SPS <br /> r <br /> Owner/Contractor: Fax: e-mail: <br /> t7 hu office/v7 rnrniyond»i!h only one den Q <br /> Signature of Owner Signature or Contractor <br /> APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />