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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 Building, South Bend, Indiana 46601 <br />Phone: 574235-798 • Fax 574-235-9578 * Email: SBSjCHPCGcost joseph.in.us <br />Website: http://wwwsgosephcau WhulWu com/*hp/index.html <br />P <br />OFFICE USE O > > T COMPLETE ANY ENTRIES CONTAINED BOX >OFFICE USE ONLY <br />Date Received , --_ Application Number <br />Past Reviews: YES (tate o/ tau Review) O <br />Staff Approval authorized by- Title: <br />Historic Commission Review Date: /a - /00 - ZO e0G <br />[I Local Landmark (Local Historic District (Name) <br />[] National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />Denied ❑ Tabled C] Sent To Committee n Approved and Issued <br />DALE <br />Address of Property for proposed work '�✓� `� y� �j�``-�� <br />Str um�ber�'`d Street Wad <br />Name of Property Owner(s): (Please Print) k/' �� �� v� G'� r <br />Address of Property Owner(s): 4 ✓��,� /,�. �' � � <br />Contractor(s) Name: `S ex e, <br />Contract Company Name: <br />Contractor Address: <br />City: r Phone: <br />Current Use of Building: <br />(Single Family —Putti <br />i-y-Faa�mily — Com -141— Goternment — industrial — Vacant — etc.) <br />Type of Building Construction: Z"va..- <br />({Hood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: l jn-kind n Landscape [] New [T`fieplacement (not in-kind) M Demolitioog,� <br />(more dart one box:uay be checked) f� <br />Descriptio of Proposed Work: /j ��rs'- ��` � �Er �i <<% 1 �,, rat/G�o` '"� <br />rJit.-►� 7`t'/ �`y .�' : G'i" l`1,•rt G� <br />W'01114 <br />/'/it t^� Yf1� r/ 1.z/l rixjG./t,,uy,,,' �,v r� p�( � GrO► r`/}r!!ui n,,rtG� � � r�/L ��?` <br />` <br />vitt 1 e t t' Ltr•1'ltlGla ldis� . �l vx chi ✓ !P ��'"ta r f �, GJ `f T'• <br />av�j • <br />Owner/Contractor. Fax: ` e-mail <br />(Thi, office will correspo)ul with only one designee) <br />and/or <br />-- APPLICATION REQLUREMENTS ARE LISTED ON REVERSE SIDE •— <br />