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SpUT88� Application <br />FOR — <br />n Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />. w 125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />1865 Mailing Address: County-City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: listoric@micliana.org <br />Website: http://communitymidiana.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY »»» DO NOT COMPLETE, ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received — Application Number 2. O O 4�- 0—" �7 <br />Past Reviews: YES (Date of Last Review) NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: .2 <br />Local Landmark Local Historic District (Name) <br />,® National Register District (Name) <br />Certificate of Appropriateness: <br />Denied [] Tabled E] Sent To Committee P4Approved and Issued -2 y' 200 <br />DATE <br />Address of Property for proposed work: P <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) r► /W o14 -CoCeI &-Hd <br />r- <br />