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I d <br />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 Building, South Bend, Indiana 46601 <br />Phone: 574 - 235 -9798 • Fax: 574 -235 -9578 • Email: SBSJCHPC @co.st joseph.in.us <br />Website: http:// www sgosephcoutityiiidiana .com /sjchp /index.html <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOY » »» OFFICE USE ONLY <br />Date Received .V vI4 o G Application Number o A 0 0 C - 0 3 Z- y <br />Past Reviews: M YES (Date of Gist Review).____ M NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />Local Landmark B Local Historic District (Name) 4� <br />i <br />National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied ❑ Tabled E] Sent To Committee E] Approved and Issued <br />DATF <br />Address of Property for proposed work: <br />Street Nwnbc•rand Street Name <br />Name of Property Owner(s): (Please Print) /,Q,� ;y SCI w l�s� !/� C. /v'c) /� L <br />Address of Property Owner(s): 5 / q ,62 f/!!:FylS <br />Contractor(s) Name: 1)_Z 4 l 1,6 <br />Contract Company Name: 9- <br />Contractor Address: Al 5� C � i /n � � J'L- <br />City: �v U �lH kvt'1 � / ���• Phone:.z � 1- - 1� �. < <br />Current Use of Building: <br />(Single Family - Multi - Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: Zal) Q D z6/'14'6e� <br />(Wood Frain - Lirick - Stone - Steel - Concrete - Other) <br />Proposed Work: In -kind E] Landscape ew Replacement ( not in -kind) - EZ-Denlolitio n <br />(more than one lux nun/ be clucked) <br />Description of Proposed Work: JQZ _i Z_Z 61 41 r)- C26- 42 6";ka�L >' <br />N D ' �4� 2 ,L� C /� <br />Owner /Contractor: Fax: .2 -� 2 — 3'-5 U e -mail <br />(This office will corresluui with onlil one designiv) <br />- 2,0 /,-,a<� _(� and /or <br />o? 8 7 . I.j AS ICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />