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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: historicernichiana.org <br />Website: http://communi". d—Liana.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY—— DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date ReceivedAOOq— OSI d _1 Application Number 2'_*0_"I _ 0510 1 <br />Past Reviews: f-1 YES (Date o/rast RMeu,) <br />Staff Approval authorized by: <br />Historic Commission Review Date: It 7 Ill ZOOM <br />Local Landmark Local Historic District (Name) <br />National Landmark ] National Register District (Name) Wim' wa' 111 Val N R <br />Certificate of Appropriateness:/—' U <br />F] Denied [] Tabled E] Sent To Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />Street Number and Street Nmne <br />Name of Property Owner(s): (Please Print) Ci /A/e./ ArJC' �. >^ C A,��: <br />Address of Property Owner(s): 16;L u+' - C 41 til x ✓ C S��r')1 (3-C vJ <br />E] NO <br />Title: <br />Contractor(s) Name: \//At( {' A/� , V 11 L b <br />Contract Company Name: VIA/ G5. -l-,- C/dAJG2CtijJ,,1CO. rsi 1WCj <br />Contractor Address: 1 a 9 W. (3a2.LC^1 <br />city: M) 4 N A Q a 1C4 <br />Phone: z.,5�6 a 011 G <br />Current Use of Building: 5IN/1 Lt , A, / l `/ . <br />(Single Fajy — Multi -Family — Contmercia► — Government — htdustrial — Vacant — etc.) <br />Type of Building Construction: W 6 1 Z 2 A M C, <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work:14 In-kind U Landscape hCl New U Kepiacement Utot in-kind) U Uemouuvn <br />(more than one box nary be clurked) i 7" <br />Description of Proposed Work: �2� C� ✓tri c Fl <br />J <br />1 IJ QC. Q Q UI YCC tl yklr. kj t✓ � R c ✓, ✓ <br />n-/ AIR. SAM S, e.J / —7 /C Al IAl 2an��irstl `iC�Le'SI �A i <br />ttt114t^,t.)S 4n �QAQcJ y; c�„Jii, �In.;E Gi'�`i�1�A/ed Ja/r'Ir1Al(C, +3iLM_ �/ <br />C.;y�� y (f1 4 iI✓C. ycm-% 5q,AAck, . /A/ 2 A cc 9S G"alw,&I q CtJ✓ <br />Owner/Contractor. Fa e-mail / ZA u/r, /1MvSn'A4do CdM <br />(nis office wit( pond with on one deli ee) <br />w-� and/or ^ <br />Sir fi3w r Signature of Contractor <br />g — APPLICATTON REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />F] <br />