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N(YrLOMPLETEAKY ENTRIES CONTAINED UqTHISDOA�FFTCE ME ONLY <br />Dale Renlved CtA.4 ZS 2005 <br />Put Reviews: ❑ YES (anarurunrn <br />StaffApproval suthorired by: <br />Appllcallou Number 2005- O 8 2..SA <br />❑ NO <br />Title; <br />Historic Corembdon Revlcw Date ?11912 0o,5 <br />❑ !Heal Landmark ❑ National Landmark <br />❑ Natlnnal Rlgilter Dl,u-id .., <br />19/I.ocal Historic Dlnho �t: lJa�,Q-s-lnf%� J <br />O <br />Certlflrale o/ Appropdaleneu: <br />❑ <br />Application <br />U B <br />-for- <br />° <br />Certificate of Appropriateness <br />❑ <br />Approved and issued <br />Historic Preservation Commission of South Bend & St. Joseph County <br />• <br />125 South Lafayette Boulevard <br />teas <br />Mailing address: 227 West Jefferson Blvd - South Bend IN 46601-1830 <br />Phone: 219-235-9798 Pax: 219-2754578 e-m2l: <br />We W4:hnpJMww.etJwephraearrledWl.ttohJchMLdnbtM <br />A Certified Local Government <br />N(YrLOMPLETEAKY ENTRIES CONTAINED UqTHISDOA�FFTCE ME ONLY <br />Dale Renlved CtA.4 ZS 2005 <br />Put Reviews: ❑ YES (anarurunrn <br />StaffApproval suthorired by: <br />Appllcallou Number 2005- O 8 2..SA <br />❑ NO <br />Title; <br />Historic Corembdon Revlcw Date ?11912 0o,5 <br />❑ !Heal Landmark ❑ National Landmark <br />❑ Natlnnal Rlgilter Dl,u-id .., <br />19/I.ocal Historic Dlnho �t: lJa�,Q-s-lnf%� J <br />O <br />Certlflrale o/ Appropdaleneu: <br />❑ <br />Dented <br />❑ <br />Tabled <br />❑ <br />Sent To Committee <br />❑ <br />Approved and issued <br />2005 <br />Address of Property for proposed work: S I / (.l4!?AR(lI<! tel+ <br />City{�/ � _ Owner's Phone N�Io:(� 2 S -7 - 76 -7 <br />Name of Property Owner(s):maom l� E N >� J9IV I) 5 RSOrI> <br />Address of Property Owner : St % C A <br />Contractor(s)Name: P14 IL PAVEY <br />Contract Company Name: P � R rods -TR tjGz IO <br />Contractor Address: 8/°] A/19N11RS7" AVE. City: _SQILH R�A1 D. <br />Contractor's Phone No�,—STq) 2,3 J_ $(/(, a <br />Current Use of Building: <br />%^l• NF ,-! n -Cow ,-Llumid-Y .-mac <br />Type of Building Construction: W00 n FRn M1/. <br />(Wetl £.W-and-.Gon•-9.d-C.I�un�.-OYw'! <br />Proposed Work: F-1Inkind ElLandscape❑ New ISI Replacemenl(...ww4 <br />!. •,. u w a. a <. w e. d. n w) <br />❑ Demolition <br />Description of Proposed Work: !-/Om6 elfJw ER 17gglIC41- <br />'C / / di 1/ Y 1 • I <br />RrS /7 0,11K9OL4, C71?Cr7- /Al M/JA19OE PARK /1AL21i RORMC)OD <br />1' - 1 orct <br />Owner/Cont}ractor Prix: e -ma <br />C Wor <br />Signature of Owner Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE LE. <br />