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Application <br />—FOR— <br />Certificate of Appropria <br />Historic Preservation Commission of South Bend <br />125 S. Lafayette Blvd., South Bend, Indian <br />Mailing Address:County-City Building,.Sauth Ber <br />Phone: 574-235-9798 • Fa:c 574235-9578 • Email-. <br />Website: http://commurtityniichiarmorg/ <br />A Certified Local Government <br />r^ <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED M THIS R »»» OFFICE tISE ONLY <br />Date Received ��".�tXJ �, Application Number �f (�) G•�� <br />Past Reviews: n YES (oateofust Review) NO <br />Staff Approval authorized by: (y t%..; _Xe-.zti� Title: e5aai.*110, ,,Pz4, � <br />Historic Commission Review Date: 12c.� .,Z A „2�5/ <br />n Local Landmark Vocal Historic District (Name) <br />E] National Landmark ]J National Register District (Name) <br />Certificate of Appropriateness: 6Z) �/,.2c0111 <br />[] Denied F1 Tabled F] Sent To Committee n Approved and Issued <br />DATE <br />Address of Property for proposed works r_66 <br />_ cit Numberpt Street N uc <br />Name of Property Owner(s): {Plcrue Print} ��t1 �s F/"� nl • jj���{'--�--- <br />Address of Property Owner(s): 717t <br />Contractor(s) Name:1 YSc4+a. A0j <br />Contract Company Name: /1lLl . 7 /P <br />Contractor Address: <br />City:y,�_ a Phone: <br />Current Use of Building: `s,(wg1e_ F" r ( q <br />(r",911 Fancily — Multi-F4,dly — Commercial — Gooernucent — Industrial — Vacant — etc.) <br />Type of Building Construction: Al AAE 14 7 new <br />(Wood Fracne — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: In-kind Ej Landscape Ba'New replacement (not in-kind) E] Demolition <br />(score than one bas nmy be checked) <br />Description of Proposed Work: <br />Owner/Contractor: Fa= 2 .�?0f"7' 4 <br />(This ofce will correspond with only one dcscgnee) <br />Signature of Oroner <br />Ii9Cc TV .464rvCg <br />/J��ail v <br />, <br />and/or ` <br />Signature of C6ntract,or <br />Il <br />