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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 joseph.irLus <br />Website: http://www.sgosephcoungrindiana.com/schp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received <br />Past Reviews: F-1 YES (Date of hst Reaiero) <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />Application Number — — — — - <br />Local Landmark F-1 Local Historic District (Name) <br />National Landmark [:] National Register District (Name) <br />❑ NO <br />Title: <br />Certificate of Appropriateness: <br />E] Denied 0 Tabled ❑ Sent To Committee F] Approved and Issued <br />DATE <br />j <br />Address of Property for proposed work: r A K A v ENv E <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) GEO(Z ES EN DZ94E <br />Address of Property Owner(s): 7 to fcwk iAVi'ttAe_ <br />Contractor(s) Name: R (C+f AK D GUML E <br />Contract Company Name: P UMF_ SEeV (CE <br />Contractor Address: 5176 21 NUID ow Amok <br />City: Ddwck6tac&I Phone: 574— 220-4q 75 <br />Current Use of Building: S� KArC �tn o�Zl v <br />t <br />'(Single Family�n—Multi-Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: W000k -rrA. '-r_ <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: In-kind [:] Landscape E] New D< Replacement (not in-kind) [] Demolition <br />(more than one lwx may be checked) 1 � <br />Description of Proposed Work: S! Kg(e Khd . R�� Ivo od , a�Km t m mm, d owl eX1eYru+► , <br />cjiX f" t,, tas4 (20 va,►rS ~rp ifee-) dot, We. kUK� (Aw-- E7 Fv;X Arn&!i/ <br />C7U2o'--Wek4f �e �r�ol� ,�i-oto.. �}o �Qi 1 t S aeco�Q�+•v �h� �eRt� <br />S74— <br />Owner/0. k <br />74—Owner/0.„k kuk. Fax: 631- S513 e-mail Ka(erle tQ no(. eA c4 <br />(This office will correspond with only one designee) <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />