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Sov r/l ee <br />r <br />labs n <br />Application <br />-tor- <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />227 West )cfferson Blvd - RM 1123 — South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic@michiana.org <br />A Certified Local Government <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANYENTRIFS CONTAINED IN THIS ROX«««OFFICE USE ONLY <br />Date Received /0fL8 206-1Application Number: 200 /tJoZp <br />Past Reviews: ❑ YES (DArroFUsraEV1r*7 El NO <br />Zoning Type: Lot Size <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />® Local Landmark <br />❑ National Register District (N—).. <br />❑ Local Historic District (Y—):_ <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ Approved and issued <br />Title: <br />❑ National Landmark <br />❑ Tabled <br />20 <br />❑ Sent To Committee <br />Address of Property for proposed work: -7 VR Sit •n C o-yft a r/ve, S. X IN ' <br />W,?' <br />Srcw N.Mn.w/ S.w, Na.v� <br />o <br />City - 4'n 1A 19-40-A-41. Township: n SpAz <br />Name of Property Owner(s):(rh/Nn <br />Address of Property Owner: ? t/ v e— <br />Contractor(s) Name: h f /}- <br />Contract Company Name: <br />Contractor Address: %[ I/}- City: o % A <br />Contractor's Phone No: Owner's Phone No: RO-Y9,7 <br />Current Use of Building: 111 h <br />(SlnIle Fewpy- U.111-F—dy. C—MIIC a! - Govnnwen(• lnduAnd - Yotan! • ea <br />Type of Building Construction: 11 Lf} <br />(Wood Frew. -Bi -Slone-Sud. Conceerr-other) <br />Proposed Work: ❑ Inkind [4 Landscape E] New E] Replacement( rttn.undt <br />(more rhos one box —y be rhectrd) <br />❑ Demolition (Completion of Seperate Form Also Required) <br />Description of Proposed Work:: <br />CtG a w�iecY SCr�07�: <br />Owner/Contractor: Fax: e-mail: V_e,.1Z n)( I r,C! • Con+ <br />(rhie oQcr will c espond with only one daiynee) <br />f0c 66 4A -19 <br />Signature of Owner Signature or Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />Any and all business of this office is handled via e-mail and jar, with least preference to U.S. flail <br />