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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 a F=574-2359578 • Email: I+Lsloric@niiclum,a.org <br />Website: http://mmmunitymichiana.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY»» » DO NOT COMPLETE ANY ENTRIF..S CONTAINED IN THIS BOX» »» OFFICE USE ONLY <br />Date Received %n1. 30• O'/ Application Number- o o d - /230 <br />Past Reviews: � YES (Datta/last seam) E] NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 0/ ' G2- ' 019 <br />Local Landmark n Local Historic District (Name) <br />[-]National Landmark National Register District (Name) Laryc_ 2 PgzK . <br />CLX.rup.FtL tag n)DScrkPE <br />Certificate of Appropriateness: <br />Denied ❑ Tabled ❑ Sent To Committee E] Approved and Issued <br />DATE <br />Lerp'erPark <br />Address of Property for proposed work: o4 LaPkye)Ee Mvl at Ague✓.3;de Dr,ae <br />S1=1 Na.,&, acrd Stwt Mate <br />Name of Property Owner(s): (Please Print)'. i l / v DF :5o.4'f, (3e J <br />Address of Property Owner(s): 0A,• of Sc,.d Ll �c n.•f I _),]-7 W14 J -e' G'sow Qer•t+ 13/x. <br />Contractor(s)Name: -SO-4" Rand CAu:rDm. o.4 -a1 q aervica_c <br />Contract Company Name: .34m e as a NZ1r/e <br />Contractor Address: .3113 lri%i vers i& Drive <br />City. _Sn;- fbL 13trtvt ; _11SA) yt�cr,a R Phone: !�_7`/ a2774S/7 <br />Current Use of Building: ND -Se'waje S4rujurr, <br />(Single family - Midd-Family - Cmmuemial - Guverrwrenl - brduslrial - Vnenrd - etc.) <br />Type of Building Construction: <br />(Waal Fra me - O.iek -Stun¢ - Shrl - Cor¢'nlr -011w) <br />Proposed Work: ❑ In-kindLandscape gNew E]Replacement (wl in -kine) [] Demolition <br />(more hurt one lox nety 6r clwkd) <br />Description of Proposed Work: <br />Passive_ <br />yv)ed;AvlJf <br />-fC 1i-er <br />10Ark <br />Me-A'loa <br />Sc Aaol area - <br />Owner/Contractor. Fa-_ e-mail <br />(T/,is <br />office will camspond will, only one dail;.m) <br />(1 ney�..r' _and/or <br />Signature o (( caner Signature of Contractor <br />— APPLICA77ON REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />