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Application <br />- FOR - <br />Certificate icate o f Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: Countyfiity Building, South Bend, Indiana 46601 <br />Phone: 574-23S-9798 • Fax: 574-235-9578 • Email: SBSJCHPC@co.st josephin.us <br />Website: http://www.sgosephcountyindiana.com/s chp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received '? k4v/- zed 6 Application Numbert O O6 - l!aovfi <br />Past Reviews: [t rYES (Date of Last Reaiety) <br />Staff' Approval authorized by: <br />[am <br />Title: <br />Historic Commission Review Date: //_ 44 " Zoo G <br />IiTfoeal Landmark [E�rocal Historic District (Name) 14.4� <br />[� National Landmark [jj�ational Register District (Name) <br />Certificate of Appropriateness: <br />Denied ❑ Tabled F] Sent To Committee R Approved and Issued <br />DATE <br />Address of Property for proposed work: -7/o ecwL Ave4que- <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) GC -00-66 S ENDerL....E, <br />Address of Property Owner(s): T10 n44'_- Ave_ <br />Contractor(s) Name: R1 Cf_(Al?_D GULL F_ <br />Contract Company Name: (L)M SF12Vlc - <br />Contractor Address: SS C 21 No �Ct.r PCK:k� <br />City: b0 tn/ac)'t RC'. f ( Phone: 74- 2 o 4 757 <br />V <br />Current Use of Building: kt t4c)(e rt y <br />(Single Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: W 000( <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: Fj In-kind E] Landscape ❑ New g Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: MGt r"Vf n tPoo'e as wo oc( t cl ou We. <br />_Strz_ e4-tc o2pt lxo c4­,c� vozc!; Nc o koc.. q'vc k , tom( cf-( tt'l�-i <br />I . V .i ~� <br />Owner/ : Fax: 674 63/ ,E-S19e-mail C3 e"ote-r (e h C. edu <br />(This office will correspond with only one designee) V _ <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />fft <br />