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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 fiend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574235-9758 Fax: 574-235.9578 • Email: SBSJCHPC®cost josephin.us <br />Website: http://www.sgosephcounq indiam.com/sjchp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONMINVED IN THIS BOX »»» OFFICE. USE ONLY <br />• !o',_ 0t o 6 G <br />Date Received ,2 471 �. Application Number_. _ — • . . <br />Past Reviews: n YES (Date of last Review) ER -KO <br />Staff Approval authorized by:, <br />Historic Commission Review Date: <br />Title: <br />Local Landmark [R*tocal Historic District (Name) <br />National Landmark [B44ational Register District (Name) <br />Certificate of Appropriateness: <br />[] Denied []Tabled ❑ Sent To Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work: & <br />Street Nyu ber and treet Name �^_ <br />Name of Property Ownersk (Please Print) V U A t " A (� `+- � S� �w+C.�e-%/- <br />- U s <br />Address of Property Owner(s): t'.1�. � <br />5 , <br />Contractor(s) Name: <br />i( <br />�- Contract Company Name: . <br />contractor Address: C% bo ve, <br />-• d City: �d•[>��C,, <br />Current Use of Building - <br />Phone: P_,.-4- - 011 U �n m <br />Cell <br />jj (Single Family — (Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: \t )oor <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: [] In-kind M Landscape ❑New Replacement (not in-kind)Demolition <br />(nwre than: one box nwy be clucked) <br />Description of Prop sed Wo <br />11 UV LA <br />or. Fax: <br />Owner/Co tract <br />11 � (Thi cepoud 'th ont ) <br />c1J <br />S t�'b �'►'1(�.� Yl ��ttY1 <br />erg sn <br />and/or <br />e-mail <br />— APPLICATION RE UIREMENTS ARE LISTED ON REVERSE SIDE — <br />