Laserfiche WebLink
O�60 �i��G _ _pp_1Ca lOri <br />\. ►�� - FOR - <br />�� Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />• <br />18 X6S 125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />f8 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax:574-235-9578 • Email: his toric@auchiana.org <br />Website: http://commur ity.n-dcl-iana.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY »»» Do NOT COMPLETE ANY ENTRIES CONTAIN D IN THIS BOX »»» OFFICE USE ONLY <br />Date Received �' Application Number'L' O <br />Past Reviews: [:] YES (Dated/List Review) Ej NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: `dt.-Aq%, 9—toi 2-0c,- <br />❑ Local Landmark ��Loeal Historic District (Name) <br />Ej National Landmark E] National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied E] Tabled E] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: F Z,/a -,F I- A:, I - <br />-�- / A. <br />Street )kumber and Street Name / <br />Name of Property Owner(s): (Please Print) . I /,, 4 t, A. )r (� 1St (- ✓' tr //'ire <br />Address of Properiy Owner(s): M_/) Ic� < T <br />Contractor(s) Name: � V- U/ /-1 ) :� t 4 <br />Contract Company Name: 11 l r, T A l & 9 /] U l' " 1-' 4 1 1, !' <br />ContractorS / R Address: //P - /) • 5/ -?V �� <br />City: 0 // <br />t rl+ 7- ' K Z"' / -�` A 1 Phone: <br />Current Use of Building: <br />(Single Family - Multi -Family - Commercial - Gorernment - Industrial - Vacant - etc.) <br />Type of Building Construction: rr t' r /< <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: ❑ In-kind E]Landscape F]New Q Replacement (not in-kind) [:] Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: �` O P 1A C• F to Ki a T r h y S/ �, �C f/X,41 <br />I/! <br />FEtr�atr,�L�C�J >vn��% �H�iv` S�ihiy�G°S tr�C-u OTT C��f� <br />YJ✓r�u'DS��• J <br />� r <br />Owne Contractor. Fax: 'i ��-.t RSr- /)XZI7 e-mail <br />(T is ce will correspond with only one designee) <br />V_ <br />' n ti h � C'i' r•., P T A �,,✓� v FCS . c. (� .-�-7 <br />V ' /L and/or <br />Sigr htre of over Signature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />