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Application <br />- FOR - <br />Certificate of Appro riat <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 45£pI <br />Mailing Address: County City Building South Bend, Indiana 46601 <br />Phone 5715 9798 Fax: 57r1-235-9578 • FJnaiL• SBSJQ PCOCo.styoseph.inus <br />Website: http://K- wstjosephcountYindiana.com/sjchP/index.html <br />OFFICE USE ONI Y »»» D0 NOT COMPLETE ANY <br />ENTRIES CONDIlrV£D W THIS B <br />Date Received pG 09 ",O <br />S Number OX >»>» OFFICE USF ONLY <br />Application Numb•2 d o s_ O 6 O g <br />Past Reviews: ❑ %E$ — — — — <br />(Darr ul Inst H�rurv) <br />Staff Approval authorized by: ❑ NO <br />Historic Commission Review Date: Title: <br />❑ Local Landmark ERfocal Historic District (N,,,ne) <br />❑ National Landmark O National Register District (Name) �IIiEr¢SiDF <br />A.eivcc <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled []Sent To Committee E]Approved and Issued <br />Address of Property for proposed work: 037 R. 1 DATE <br />•`�Sr per. On:V'C <br />Name of Property Owner(s)' (plea,,, prb,t) <br />Sint•t NumLer nail Street Nmne <br />Address of Property 3—��-a'-��--��_��;J�J.O-�'�--- <br />P tyOwner(s): �O�j (�,ve 5r <br />Contractor(s) Name: 1299.E <br />nl t}h6 j G <br />Contract Company Name: <br />Contractor Address: C✓S�o�✓a Mu��� <br />S2 z 3 <br />City: ()J'Q^ce_, 1 nl <br />Current Use of Building:. Phone: 'Z } Z_ 0 p <br />Type Of BuildingCortstr uetiun; (Si°glrfnrrrily-Mufti-FannLt_Coe,u.•rtird-(grrxrgerrt-Ledustrin!-Vacnrtf- <br />rte) <br />Proposed ( wood Frnu,e - Brick - Stone - Steel - Concrete - <br />Prop Work: � In-kind Ot1nr) <br />(nmrctimnoeebox nmyIVChocked) (.'Landscape 0NeW <br />❑ Replacement (not in -kiwi) <br />Description of Proposed Work: RG•v,ra J Af [�'Bemolition <br />?rv_7<�ICXcv.'P�, Tree Grsvie 5rtse �rYt: 2�YeeZ` . � <br />rgs.t„e. <br />I `'P-4 <br />ror �i out$. TWs r rh 64 <br />�2r9s n to 4 ire v b : e a <br />ri, 7 -ir:�/y 6'rrrt, op <br />Owner/Contractor: Fax: ,-j-LJ <br />(77is office wilt cormsµ,+, I - 69 <br />1.11 unty one• Ar '3 o n 6`t't4 7180,.., <br />e-mail11100&t. I a <br />_Ph <br />— I <br />----.-------- _and/or__ <br />r7;'t I l wZr,7 .rq, — APPLICATION REQUIREMENTS- - <br />4; ,a r b•v of t R v ARE LISTED ON REVERSE SIDE — <br />n'y}sd <br />R <br />