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,OUT& Application •"""r••a <br />FOR - .- <br />�y� Certificate of Appropriateness a <br />Historic Preservation Commission of South Bend & St. Joseph County <br />9 � <br />125 S. Lafayette Blvd., South Bend, Indiam 46601 s, J• <br />rats Mailing Address: County -City Building, South (fend, Indiana 46601 <br />Phone:574-2159798 • Fax:574-2759578 • EmaiL• historicumichiana.org <br />Website. http://mmmunitynikhiaiie.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY>»», no NOT CQWPfETF ANY EA IES CONTAINED IN THIS BOX »»,, OFFICE USE ONLY <br />Date Received <br />.I06 APP ao Application Number u S - 0707 <br />Past Reviews: ❑ YES (ar,aft.0 Rm a,) ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: 7-l? <br />❑ Local Landmark ?(Local Historic District 1Nam4 <br />❑ National Landmark (Tf National Register District W.-,) � ^•'E <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued Dan <br />i ver �l�t z tri �e_ <br />Address of Property for proposed work: 6130 <br />Shen Namtw auud Simi Name <br />Name of Property Owner(s): (rteauP i -l) 11V 1 it l(AYA ar� hah <br />(�� <br />Address of Property Owner(s): VI X30 R1 ve'rS (I e- ow-, I �� <br />Contractor(s) Name:�I j 7�n 1\1j�I� <br />Contract Company Name- (, Owe- `"l'Yt'5 <br />Contractor Address: Till <br />A91� ) ti Phone: <br />City: hrtu.nllll. IN 9hS4- <br />`a le- i raml l <br />Current Use of Building: r <br />(Si Ir Fnmily-Mu,�ltyi��Fpnr ily- <br />Comnorcial-Coucrnmenf- Indusfrinl- Varanf - eta) <br />Type of Building Construction: \N MCI 1�r=d Fmnrt-ariak-Sion,-Sim-Concrete-Other) <br />Proposed Work: ❑ In-kind ❑ Landscape ❑ New ❑ Replacement (not ire --kind) ❑ Demolition <br />(more tlnn one Lva nary he daet nt) <br />;nk:h;e (ra vs <br />Description of Proposed Work:—rWO".>�n1 Orirllhrn7 � i'Xlrk, n_r , -I <br />lrir.v 6C t-in7ktL nnvJ ate "j,,,S'iTm W II l7• 1w' wrri,� a,4'8'e- �e�. <br />-nit (1X %, rl 'I IK ar(d, hm w II hr bylf.l� a ni 11� s1a �� will mei <br />(edar nnR 'Iha vufrrlc,>a5 u/11l I,. i,m�Yl ihL roa�ina M�kritil will oc 1� <br />—� r vexf/cl vdn k <br />Jl� f� (�bovg c2 JC Or � ^�- r' r <br />)lfn� i)vililleGl (Qs+ SEvlsrKf 2� 7 P(� <br />Owne onteactor. Fax: 2'W. 1�5. n5� email \'a' Aon +P hohmi'LrO.n <br />,J��l2Alst)�� Ifl Pf 101G'l. .and/or <br />JIM o} wner Signature of Contractor <br />N RE UIRENETR5 ARE LISTED ON REVERSE SIDE — <br />