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Application. <br />BOUT d _ for - ` rnsroar+i <br />o ttilCertificate of Appropriateness' <br />Historic Preservation Commission of South Bend & SL Joseph County <br />less 227 West Jefferson Blvd - RM 1123 -- South Bend IN 46601-1830 <br />Phone: 219-235-9798 Far: 219-235-9578 e-mail: historie®michiana.org <br />r:n . t , r t .nr•r •:. r + A Certified Local' <br />Government <br />OF,"CS USE ONL11-2---DO Nar COMrLrm ANY ViTam CONrAwED iN Tms atOX<<<«<Omcjr uSEONlr <br />Date Recelved_ `G ,IO i 20 O i APpiiation Number. 200 a 6le, <br />Past Reviews YJ YES (tu�corusr�tmtm (/LNG.. _2Cb3 a <br />/- ANO <br />Zoning Type: ZIA , . Lot size <br />Staff Approval authorized by: Title: <br />Historic Commbsioe Review Date: <br />Local Landmark + . > : National Landmark' <br />National Register District d—.e l /" <br />' ❑Local Historic District fm-4: <br />Certificate of Appropriateness: <br />DeniedTabled Sent To Committee <br />' ❑ Approved and Issued - •, 20 <br />Address of Property for proposed work: <br />City : �o grr� .: !' Township: <br />Name of Property Owner(s):rranm %'.� do 6* <br />Address of Property Owner: 321 F 031iids Salk 6e 1 `lWali <br />Contractor(s) Name: C a� S.JI+ �.� art <br />Contract Company Name: <br />Contractor Add less: ' 'j ' City: <br />Contractor's Phone No: Owner's Phone No:' <br />Current Use of Building: <br />S (SiaebT Fa.nlb•-M�b'4FaaY4-Caws.vrLl•Gare•a.eat-lafnrb4l•Yacand•ete - . <br />Type of Building Construction: <br />(wwf Front- Arks -Mom -Sled -C WW* -000 . <br />Proposed Work: Inkind Landscape New [j Replacement(—bm&.4 <br />(woe da, ane bar aqr M eFebetl - <br />❑ Demolition (Completion of Seveate Form Also Required) - <br />Description of Proposed Work: Q•ae .rep lei V. 4, - �efe1 �•'r as <br />Gc Imes rwA Ibib ,da.r4AK. car • J,.ae U-31 ;a AA K.r <br />'... .. � �•,:�1 �'. I�.rlt tet car.. . �i .•i T:: t.. t t , <br />-- — __— Owner/Contractorr`F ax: '' "— e-mail: <br />. r(!Lb•Dkv rWcrorrsgwlydA aJy ane 6+/pwl .: r - - <br />Signature of Owner Signature of Contactor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />Any and all business of this oJJ'lee 1t handled via e-mail and fav, with least preference to U.& Mall <br />J <br />