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Application <br />- FOR - <br />Certificate of Appropilateiiess <br />Historic PITSCI-Vatioll COIIIIIINSi011 of South Bend & St. Joseph County <br />12; S. Lafayette Bend, Indiana 40001 <br />N lit i I ill,, Address: Col Ill ty-Citv R, I i I firl,, I, P.— 4 1-4; <br />Phone:574-2?3-(47QS - Fav574-215-9578 - Ell 1,71i 1: SP)SK H PC "! C0.St-joSCP1 1. ill. LIS <br />Website: http://%y%cw.stjusepha)untyiiidiana.Cum/sjchp/inLles.html <br />OFFICE USE ONLY-- DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS 13OX >>>>>> OFFICE USE ONLY <br />Date Received '?4t 'Zooc. Application Number o2 OO <br />Past Reviews: YES 1.,-, 1"", wJ F-] NO <br />Staff Approval authorized by <br />Historic Commission Review Date: <br />Fj Local Landmark 2Local Historic District (.vans) <br />F-1 National Landmark E] National Register District (.vame) <br />Title: <br />Certificate of'Appropriateness: <br />0 Denied F-] Tabled E] Sent To Committee � Approved and Issued <br />Address of'Property for proposed work: <br />Address of Property Owner(s): J') <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />CRY:- Phone: <br />Current Use ofBtfl1din---_-_-, <br />Type of 131.1ildill" C0IIStI-1IVti0II: <br />Proposed Work: 0 hi -kind E] Landscape New Replacement Demolition <br />(mow thall 0!" 1,01UM11 b, !1' , "wd) <br />Description of'Proposed Work: <br />L <br />r ri i7i IV( i i'vc <br />7 <br />1j <br />Owner/Contractor: Fax: e-mail <br />,I ild /or <br />APPLICATION REQUIREMENTS ARE_ LISTED ON REITRSE SIDL <br />