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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: 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 S6C7W;9EJ0G 2000 Application Number-? O Oho _ /005.4 <br />Past Reviews: EVES (Date of t ast Review) 9' /I -.Z d O 6 ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />R<ocal Landmark Woeal Historic District (Name) dZ4'4 rJ TL -k <br />[ Kational Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />Denied Ej Tabled E] Sent To Committee E] Approved and Issued <br />Address of Property for proposed work: <br />Name of Property Owner(s): (Please Print) <br />To Pot rk AVB , <br />Street Number and Street Name <br />6EOIZ6 S ENDF—PLE <br />DATE <br />Address of Property Owner(s): WO Pp r1-14ve-, <br />Contractor(s) Name: (Z I CP FV t2 I- <br />.> r -t V NTL E <br />Contract Company Name: NONE SERVICE. <br />Contractor Address: EE621 A11AbOµt- (240CIA <br />City: Do wa°I t GiC Mt Phone: 574- 220 4¢7�S <br />V r /�, <br />Current Use of Building- 'Si <br />