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L-,Xlj kation <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 josephjn us <br />Website: http://www.sqosephcounqindiana.com/s chp/index.html <br />OFFICE USE ON » » COMPLETE ANY ENTRIES CONW INErO X » > FFICE USE ONLY <br />Date Received• d=-b� •. c lNli/ Application Number '� <br />n YES (Date of cast Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: /a2-/P'Zaa G <br />❑ Local Landmark Veal Historic District (Name)�Ct EtvAr. <br />E] National Landmark n National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied ❑ Tabled n Sent To Committee ❑ Approved and Issued <br />Address of Property for proposed work: 2 3 3 !l r� 0r i S n /I <br />��11 Street Number and Street Name <br />Name of Property Owner(s): (please Print) j20� P.�/' Tbit 1 Q <br />Address of Property Owner(s): �, �� �S i7'20 l ✓t � <br />Contractor(s)Name: ��� �(zp�_`o ?•Q <br />Contract Company Name: <br />Contractor Address: 0/0�6:7 - c)CVV- > <br />City:_ . ;Qs t 4A _ ,nA;� / Phone: S` Z4� - �' 0 <br />S 7 <br />Current Use of Building: �p /I'— -a.-) 410. <br />(Single Family Multi -Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction:V-1!�� 1 a( t VN. 4 <br />( ood Frame - Brick - Sdne - Steel - Concrete - Other) <br />Proposed Work: ❑ In-kind R Landscape [New Replacement (not in-kind) [:] Demolition. <br />(more than one box may be checked) <br />Description of Proposed Work: ��Ul tYl / /✓1 t lv a_1Yl dt✓ �G�rtt <br />P'a1r o.T <br />Owner/Contractor: Fax: e-mail <br />(This office will comspvnd with only one designee) <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />