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I <br />Application <br />- for - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 South Lafayette Boulevard <br />Mailing address: 227 West Jefferson Blvd - South Bend rN 46601 -1830 <br />Phone: 219 - 235 -9798 Fax: 219- 235 -9578 e-mail: SBSJCHPC @cast- laeeph.i&u <br />W ebslte: http:lt www. stloxphcountylndian &com/slchpMdes.html <br />A Certified Local Government <br />Office we only » »>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX>>>OFF)CE USE ONLY <br />Date Received /y N'Ae Q- 2006 Application Number: 2006- O <br />Past Reviews: p YES (DATEOFl-1SrAEvzEa1 2-00 2� ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: at <br />❑ Local Landmark ❑ National Landmark <br />❑ National Register District txamq: <br />Local Historic District (xamv: 1 Yd• na A <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued 2006 <br />J <br />Address of Property for proposed work: J (� 'v <br />Sr,,.1. raker and 5­1 <br />City Owner's Phone No: <br />Name of Property OWner(S):(PRINT) a0b Y� Luc7 7 OAes <br />Address of Property Owner <br />Contractor(s) Name: Q tj ite j - <br />Contract Company Name- <br />Contractor Address: City: <br />`. Contractor's Phone No: Q D rr <br />Current Use of Building: SIKA[e 1 /y /�Q,SIOC'nCe <br />1 (Satgle M— ly- Mala -F rndy -Comm W- Government- Indwmal- Vacant -ac <br />Type of Building Construction: <br />(Wood Frame - Bnck - Stone - Steel - Conaete - Other) <br />Proposed Work: ❑ Inkind Landscape ❑ New ❑ Replacement(notin -kind) <br />(more than one boz may be checked) 9 <br />❑ Demolition <br />Description of Proposed Work: S",KO /e.Ke -t� iQ.t� 1�`Qn <br />Q� Q eld ( ".544r ta-JJ -1 <br />Yeee� ' ixa � oxl yte�a.�t«. r L>✓'teeludsc� <br />V U <br />Own nt r: Fax: - 3/ — G ;Ls e -mail: r` j vases j (d /td, edd <br />(Ihu o r wit only one du gnee) <br />& /or <br />Signature of pw r/ / Signature of Contractor <br />`/ APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />