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Application <br />- FOR - <br />Certificate i'cate 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: County -qty Building, South Bend, Indiana 46601 <br />Phone. 574235 -9798 • Fax: 574 -235 -9578 • Emaih SB$JCHPC®co.st joseph.imus <br />Website. http:// www. sgosephcounVffidiana .com /*hp /index.html <br />OFFICE USE ONLY ­­—DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received Application Number — 1 1 0 7 <br />Past Reviews: E ES (Dote of fast Reoiem) <br />Staff Approval authorized by: ' <br />Title: <br />Historic Commission Review Date: <br />Local Landmark B"LLocal Historic District (Name) <br />National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied [] Tabled E] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: 119 South S t <br />Street Number and Street Name <br />Name of'Petitioner is (PlamPrint) Code Enforcement <br />Address of Petitioner 227 W Jefferson Blvd Rm 1300 <br />Contractor(s) Name: Pelley Excavatine <br />Contract Company Name: <br />Contractor Address: 1990 Pro Dr <br />City: Niles, MI Phone: 269 - 683 -2947 <br />, <br />Current Use of Building: Abandoned Home <br />(Single Family — Multi - Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: Wood Frame <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: Cj In -kind E] Landscape E] New ❑ Replacement (not in -kind) QX Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: Demolish all structures, fill. tovsoil. & seed <br />Petit ione.liContractor: Fax: 574 - 235 -7703 <br />e-mail Ctovve (asouthhPndi n _ srnv <br />nd with only one designee) 7 <br />and /or <br />Catherine Toppel <br />— APPLICATTON REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />