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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: 574-235-9798 • Fax- 574-235-9578 • Email: historic@michiana.org <br />Website: http://commurdtymicWana.org/historic/ <br />A Certified Local Government <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received .21a7 12t,-OC.r Application Number 2 O O (r - 02-Zt7- <br />Past Reviews: 9 YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: ATF -60 CLQ <br />;Local Landmark ❑ Local Historic District (Name) <br />❑ National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />Denied ❑ Tabled [3 Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: 47% ` L= - ��'� <br />I Street Number an <br />S reet Name <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner(s). ` <br />Contractor(s)Name: C-kevk4 S lc1 r�- <br />Contract Company Name: \ �'� 1 C-\� <br />C41111— <br />Contractor Address: 1 �S'C� r I Vere <br />City: S O ICY Phone: <br />Current Use of Building: 7 r1a� <br />(Sing! amity -Multi -Family -Co mer 'a -Cover nt-Indus�ial- Vacant -etc.) <br />Type of Building Construction: '5 I C. C.O <br />( Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: In-kind [:] Landscape Fq-Kew n Replacement (not in-kind) ElDemolition <br />(more than one box may be clucked) <br />Description of Proposed Work: 4D�C&11 <br />�� <br />dun XItiA c e -A r N M �.-n t i <br />wed) <br />d <br />Owner/Contractor. Fax- e-mail <br />(This office will correspond udt/h only one designee) <br />w •and/or <br />Signature of Owner Signature of Contractor <br />— APPLICATION REQtHREME M ARE LISTED ON REVERSE SIDE — <br />