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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 Buddin South Bend, hidiana 46601 <br />Phone: 574-235-9798 • Fax:574.235-9578 • Email: historic4hnicluana.org <br />Website: http://commurdty.niichiina.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY », » DO NOT COMPLETE ANY FNTRIFS rONTAINFO IN THIS BOX »»» OFFICE USE ONLY <br />Date Received -1-VS- OeL /y Application Number aO U5 - /O /2. <br />Past Reviews: ErYES (Datea/Wst Remna) <br />Staff Approval authorized by: t <br />Historic Commission Review Date: <br />F_�NO <br />Title: <br />Local Landmark []'Local Historic District wamet .Gt/Gf- � .lf�tCeetG <br />National Landmark National Register District (Na.o <br />Certificate of Appropriateness: <br />Denied [] Tabled E] Sent To Committee [] Approved and Issued <br />/ t� DA <br />^TE <br />[� <br />Address of Property for proposed work: I I I I I \ 1 ve Vr 1 GIP D r i ult- ) O t47/Yl <br />Street Number and S,nyt'lame <br />(� <br />Name of Property Owner(s): (Please Print) tl I �UC-/laPto Ws k,' Cc 1//�Y�r( 13-k4yr X- / YlrOtt/I'e-t <br />Address of Property Owner(s): I I I I I WPICS tsIt Y i V -t- Jd'-71 , SIV <br />I' 1 IIIIII //chid/G <br />Contractor(s) Name: IA VV40P\y �! I,UW <br />1rtd dv LNU' <br />Contract Company Name: (^ I , 7� A� <br />Contractor Address: '2Zo3 ) t On LI�YVI f�G.t'�si e t'1 t, C <br />City: �tAtM 1 huh 1166 3 Phone: 573-L/- �Z :7-I- } / &K? <br />Current Use of Building: 1 V �L � vM fWI V <br />t(Slingle Fnml ily-/M`h-fnwity - Connuenml-Couenuuent - Industrial - Vacant - etc.) <br />Type of Building Construction: U )nnA 1-Yr� <br />(W*0 Fmme - Brick - St!,y,t§ - Steel -Concrete - Other) <br />Proposed Work: In-kind Landscape New Replacement (not in-kind) E] Demolition <br />molition <br />(more than one Gor umybe checked �. 0.V e_ r1U� SU vt W%1/G.4t app lief . we cc vp s# lea iM fN wt"V, M"Im <br />�Ne be I evc- , f I , (<�tC" „ / / JJ �/ 'fee <br />Description oi-Proposed Work: f, 11/tS �I 4' W6ed T12Vt� . 5'e cN1� y7UtN <br />tuie,dows - -PL & vinyl -c , doL(ble.-hkrj wivlk"W l l b�_ <br />Pitt Air de +/,. �e,Xit1,� wdc4ert -6o Fne-i. Tk"cuvr",t jr,�A <br />funs '14 +- tvindbwr tv,I( b'0_ rtlktVlLl a Weal, (1W att�lk <br />arbakV"'a q �!-N/� hnue.e- to II 4Nte re_&' be_ ✓rt�l'n fn 'heo/r 7-!1e'- cvst <br />15 18, 006 - rT [�� elt p (-� ( 1 4e\, cu mev/x{�oh rm f e-vrl l'd') <br />-}IA Vt f "i- )VQn uUr1r\d-4)WS 1ve Pol-K r4 eli4J 7naha 1/0 it l <br />Owner/�bx Fax: e-mail b kgr {'1d h e ) i u,t b , v ti is <br />(77,15 o#lce will correspond with only me daigna) <br />k>o�+ bl(nawlQsa7%+rb. rc(�� <br />and/or _ <br />Signature of Owners Signature of Contractor <br />— APPLICATION REQUIRL'SIEATS 4RE LISTED ON REVERSE SIDE — <br />