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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />121; S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: Countv-City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: j-74-235-9578 • Email: SBSJCHPC@co.st-joseph.in.us <br />IFlrebsite: http://wwtivsgosepheount3,indiana.com/s chp/index.hhi-d <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTUNED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received /a' (v 0� Application Number 20 0 S - /0 of <br />Past Reviews: V YES (r)an-q(Lw)Z,-ie.) <br />Staff Approval authorized by: <br />❑ NO <br />Title: <br />Historic Commission Review Date: 10-17-7-005- <br />E] <br />0-/%-2005❑ Local Landmark Local Historic District (Nn,ne) <br />National Landmark [National Register District (Nand <br />Certificate of Appropriateness: <br />❑ Denied [-]Tabled ❑Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: 62-8 PAfLK AVE. ',6V7rH BEND IN tllo(olb <br />Street Num6rr and Strrd Hari <br />Name of Property Owner(s): (Please t'rint) C 0 (:NF 1-1 0 5 F A I) `A A A H M tG k-LbM <br />Address of Property Owner(s): 10 2 $ PA kk A u F <br />Contractor(s) Name: TD RC DET,F AM , AIF r <br />Contract Company Name: <br />Contractor Address: <br />City: _ Phone: <br />Current Use of Building: s I N & L£ FAM t W <br />(Single Fmnily -Multi-Family - Co,mnereial - Gmwon tent - Industrial - Vacant - etc.) <br />Type of Building Construction: A 2IC-I_ <br />( wont Frame - Brick - Slow - Stal - Concrch - Other) <br />Proposed Work: ❑ In-kind CKLandscape ❑ New ❑ Replacement (not in-kind) E] Demolition <br />(more no,, one bm nmy lw cheArd) <br />Description of Proposed Work: fR9141 OF HOUSE: ROD $EM% - GP -C -VL -AR jEp-p'ACE <br />IN FRONT OP tKSNGYI Doo ke, WITlJ- fAtJDSc.APIN(p OP Stifzwm, (4mD <br />&PLA55E5. Au TMAW, T(ZEF IN TArl-F LAWN TO "PLA Ce ONE CVTC>0WA), <br />SIhE: Abp i)01c1( PA -r14 C6NNEe-n r4& SuN Roam $li)E f)on/t tD 1)2tt)et nL/ <br />Owner/Contractor. Fax e-mail S GM IGK LC -M Q R D L GO AA <br />(Deis of a-ail/einneir nd avlh only onr designee) <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />