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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 BIvd., 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 josephin.us <br />Website: http,//www.sgosephcountyindiana.com/sjchp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANYENTRIES CONT TUNED IN THIS BOX—-- OFFICE USE ONLY <br />Date Received 7- // ^ a Otte Application Number d 00 G - 0.711 <br />Past Reviews: r-1 YES (Date of Last Rmkm) F-1 NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 7 - /'1 a OV6 <br />E] Local Landmark 21mcal Historic District (Name) 5 %tiayxL ,k t•• f <br />National Landmark E] National Register District (Name) 0 <br />Certificate of Appropriateness: <br />[l Denied ❑ Tabled n Sent To Committee F] Approved and Issued <br />v '^; DATE <br />' Address of Property for proposed work: <br />/ �uU Street Number,�j nd Street Name <br />Name of Property Owner(s): (Please Print) L, Ue �/vl�'lrIL �77WW;012 ( .23Y-&0Z0� <br />Address of Pro s f <br />Property Owner(): G, 5�% <br />Contractors) Name: I A h /A'p1,i�1 . 1 fra <br />Contract Company Name: l.1 W P & / (� <br />Contractor Address: r S <br />X1 <br />City: 9 P fl�/)%077Phone:_U,? oq� <br />Current Use of Building: / am (u <br />vel <br />(Single Family �-Aulti­Family —Commercial — Government —industrial —Vacant —etc.) <br />Type of Building Construction: bi is - <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: E] In-kind [] Landscape W New E] Replacement (not in-kind) [:] Demolition <br />(more than one box may be checked) / <br />Description of Proposed Work: SeYeehY4 /l�fe- i QG�r f[ot-, 'FU bae-k 6,c /Q cv;e <br />� r <br />L. V gar : LZaeeQ Cepplfer- 5eCR.Q it <br />�a P,� SO c& Of 11' 1" W 01 ��2/ <br />Aou5e. SidMIne i n L -t rd hp_-teh t <br />9w.ne-r ontractor: Fax: 57q- ;3'4 - ZZ q 3 <br />Gs o c'Ai correspond with y one d ignee) <br />and/or <br />o o4f 4 W o/� <br />e-mail 4tl ACL t1 e-QOl Con�N_ <br />v <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />Ro0-� AlafCA rest- e -F h&n'e. (PhLowe st" �ccr tai.. , <br />