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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 Buildu1g, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Eniafl:SBSJCHPC@co.st-joseph.in.us <br />Website: http://www.stjosephcountyindiana.com/sjchp/index.hlmi <br />OFFICE USE ONLY»»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 10 Application Number cZ 0 O S - 10AfA <br />Past Reviews: ❑ YES (Date of Inst Rrviete) t NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />Local Landmark ❑ Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (None) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: 2300 Portage Avenue, South Bend <br />Street Number and Street Naine <br />Name of Property Owner(s): (Pleasenrint) Alderwoods Group, Inc. <br />Address of Property Owner(s): <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Current Use of Building: varnnt <br />259 Yorkland Rd., Toronto, Canada, M2J 5132 <br />Phone: <br />(Single Family - Midti-Family - Connmercial - Gnvennnent - Indnstriat - Vacant - etc.) <br />Type of Building Construction: combination wood frame and stone <br />(Word Frame - Brick - Stone - Stmt - Concrete - Other) <br />Proposed Work: ❑ In-kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ® Demolition <br />(more t/um mie box nmq he checked) <br />Description of Proposed Work: Please see attached description. <br />Owner/Contractor: Fax: (97L)?47-07Ro <br />(This office eoill correspond with only one desiy�eec <br />e-mail ppr;mmor(dma\*l rhor rpm <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />