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Application <br />SpU T1t g - for - <br />°4 Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />1865 227 West Jefferson Blvd - Rhl 1123 - South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic@michiana.org <br />michiana.org <br />A Certified Local Government <br />OFFICE USEONLr»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USEONLr <br />Date Received OS/O/ 200,1 Application Number: 200 0S_,0/ <br />Past Reviews: , El YES (DAiroFLIsTAwEM7 r_1 NO <br />Zoning Type: <br />Staff Approval authorized by: <br />Lot Size <br />Title: <br />Historic Commission Re (ew Date: <br />Local Landmark (I-.efeF-_P�L) Ej National Landmark <br />National Register District (m—;: �-- n Polk <br />Local Historic District (or): ((( <br />Certificate of Appropriateness: <br />ElDenied ElTabled Sent To Committee <br />Approved and issued 20 <br />Address of Property for proposed work: T�) t- <br />Se'In Nrr.ker od $6erf N <br />City: Sn,.�(,, r"iv.-1 Township: Sr �fl.cef�� <br />Name of Property Owner(s):rnuvn C., i- 6q a.'J-(.. Z)o,1d <br />Address of Property Owner: /.9-S S 2 �x� <br />Si'// t! G pn <br />Contractor(s) Name: - Gi,c�. - �!,ku,CcXt 6a�afn - cy` - S 6 <br />Contract Company Name: , Z 14r .,0 �) t - L . Lt _1 <br />Contractor Address: <br />City: <br />Contractor's Phone No: Owner's Phone No: <br />Current Use of Building:y- <br />(Sint(e Fomilj - Mutrf-Fam,(y - Com,nercial • Cowfinrn(• Indutdial •Vac%% • r(c <br />Type of Building Construction: t <br />(Wood Frame - Brick . Stone -Sreet • Concrae - Orher) <br />Proposed Work: E] Inkind F� Landscape Z New R Replacement(-iln-kind) <br />(mun ,hv, one hoe w,ay h. rherke� . <br />Demolition (Completion of Seperate Form Also Required) <br />Description of Proposed Work: [.r. �' �,� ctcz.oX t r, L'•�F� E- <br />�L�ttd 1. Gk ze <br />Owner/Cont ctor: Fax: e-mail: <br />(!hu office will co po,d irh only q�r draign ) <br />t. XA a/ <br />Signatu weer Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />Arty and all business of this ofJlce is handled via e-mail and fax, with least preference to U.S. ,Mil <br />