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- for - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 South Lafayette Boulevard <br />Mailing address: 227 West Jefferson Blvd - South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: SB&ICI ?C@co.tt-jo.Ph.ln.us <br />We bsite:http:lhvww.st josephcountylndiana.com/sjchpMde:.html <br />A Certified Local Government <br />Office use only»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BO.h»OFFICE USE ONLY <br />Date Received -I " / 2006 <br />Past Reviews: ❑ YES (LUTE OFLISrREVIEM <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />® Local Landmark <br />❑ National Register District (Nam,): <br />❑ Local Historic District p✓am./: <br />Certificate of Appropriateness: <br />❑ Denied <br />Application Number: 2006- 650 / <br />❑ NO <br />Title: <br />❑ National Landmark <br />❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued 2006 <br />Address of Property for proposed work: 121 <br />Str.eM'umbrr mdSoea �Na[me) <br />�+ �' //'� p / SST <br />City: Sou�-yl !� enol Owner's Phone No: - 2-3 Z -.SSO'7 <br />Name of Property OWner(S):(PjasT) A/, /J,1- -e- <br />Address <br />Address of Property Owner : / 7_ b,,-ke r J5'� <br />Contractor(s) Name: <br />1 v <br />Contract Company Name:amtt <br />Contractor Address: City:(go �e.rd -N <br />Contractor's Phone No: <br />Current Use of Building: t n q' <br />(Single roily - Multi-F(amily - Comm%real. Government. Industrial- Vacant. etc. <br />Type of Building Construction: '^j tend a�rn <br />(Wood Frame -Brick - Slone -Steel - Concrete - Other) <br />Proposed Work: _P Inkind ❑ Landscape ❑ New ❑ Replacement(nain-Aindl <br />(mon than one bar may be checked) <br />❑ Demolition <br />Description of Proposed Work: <br />%tan (drrz-, Is <br />repl,tcQ.. 0,( C_�A,. lxoVE S2�Alr5 ell <br />Owner/Contractor: Fax: a-mail:nj�P 3C-),VAJ, t^at7 <br />�hu oAQictivnlf rnrru onlyy LnrrJ j <br />1 Z of &/or <br />Signature of dwner Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVFaRSE SIDE. <br />