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Application <br />-FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax -574-235-9578 • Email: historic@micliiana.org <br />Website: http://commurdtyniichiana.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY >>»>> DO NOT CO,NfPLETE ANY ENTRIES CONTAINED IN THIS BO » — OFFICE USE ONLY <br />Date Received ^ �t?Oe>r Application Number' -2-'o U "( - 055p4 - <br />Past Reviews: U YES (Dutebltrst rz oin) NO <br />Staff Approval authorized by: Title: <br />, <br />Historic Commission Review Date: l l Z4 de <br />Local Landmark F-1LocalHistoric District (Name) <br />National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied E] Tabled E] Sent To Committee n Approved and Issued <br />DATE <br />Address of Property for proposed work- 312 E. Donmoyer Avenue; South Bend, Indiana <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) South Bend Community School Corporation <br />Address of Property Owner(s): <br />Architect's <br />RHMIffiffiffl Name: <br />Architect <br />94MCompany Name: <br />Architect <br />A r(tftlddress: <br />City: South Bend <br />Current Use of Building: <br />Type of Building Construction: <br />635 S. Main Street; South Bend, Indiana 46601 <br />George F. W. Weber III, AIA <br />Forum Architects, LLC <br />122 S. Michigan Street - Suite 200 <br />Phone: (574) 233-2119 <br />Educational Facility <br />(Single Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Tuckpointing/waterproofing Brick and Limestone <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: X't In-kind E] Landscape F� New ® Replacement (not in-kind) E] Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: See attachment <br />Architect <br />MAJAWINUMNYM Fax: (574) 288-0924 e-mail weber@forumarchitectsllc.com <br />(77tis will correspond with only one designee) <br />Q 58�S C., and/or <br />%ignature of Owner C Y ISignature of Contractor <br />/ — APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />