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Application <br />- for - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />227 West Jefferson Blvd - RM 1123 -- South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic@michiana.oro <br />A Certified Local Government <br />OFFICE USE ONL i>»»>DO NOT COMPLETE ANY ENTRMS CONTAINED IN THIS BOK«««OFFICE USE ONLY <br />Date Received U�b64 20OY— Application Number: 200#030q <br />b30q <br />Past Reviews: % YES (PA1FUh'lAd71tf17I7n ❑ NO <br />Zoning Type: Lot Size <br />Staff Approval authorized by: Title: <br />� <br />Historic Commission Review Date: f��t-C� �S '';L0Or� <br />0 <br />Local Landmark j <br />X1, ational LandmarkNational Register District (N r &,t 1 Cu -t \� <br />❑ Local Historic District (x—): f <br />Certificate of Appropriateness: <br />❑Denied ❑Tabled ❑ Sent To Committee <br />❑ Approved and issued 20 <br />Address of Property for proposed work: Wim(' <br />.beer N+mM and SrreeI N—) <br />City Township: <br />Name of Property Owner(s):mrrm Q1, 0� Sates L�[�c <br />Address of Property Owner: F: <br />Contractor(s) Name: <br />Contract Company Name: C•�t j tel` �,,J <br />Contractor Address: City: <br />Contractor's Phone No: '45S-'47117 Ott jqq Owner's Phone No: <br />Current Use of Building: <br />(Single Fatuity - htattt-Fatuity-Cammtrciot -Government- Industria! - t scant- eta <br />Type of Building Construction: <br />(n'nan! Frame -Brick • Slone -Steel • Concrete - Other) <br />Proposed Work: ❑ Inkind 5 Landscape ❑ New ❑ Replacementmotin.kind) <br />(mare than ane ha may he checked) <br />❑ Demolition (Completion of Seuerate Form Also Required) <br />Description of Proposed yWork: t 1�.:r -1a G4. , ,ld� i,, It 4e.>x peek jne,a I, t <br />grOq i?.vaof l�'. XT 4'-. 60otn Aarei (}tc, 11�e SOUrtc O` l�e �4l,l,_. Re nttte M,J Ui' <br />«e krce.% dope %'^ Lt.e Rik <br />Owner/Contractor: Fax: e-mail: <br />(Ibis affce wdt cnmesrand wtrh only one dedgnee) <br />Signature of Owner Signature of Contractor <br />APPLICATION REQUIRE}IENTS ARE LISTED ON REVERSE SIDE. <br />Any and all business of this office Is handled via e-mail and jax, with least preference to U.S. rltail <br />