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Application <br />- FOR - <br />Certi ficate 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 - Emait SWCHPC&o.st joseph.in.us <br />Website: http:/ /www.slosephcountyindiana.com /s chp /index.hbl I <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received Application Number 0 0 0 7- 6 G A <br />Past Reviews: ❑ YES (mte of Lot Review) � NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: A U 0 7 <br />Local Landmark F] Local Historic District (Name) <br />F] National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied E] Tabled ❑ Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: Ij • .,/ �� ' i`.) S -rr , <br />Street Number and Street Name <br />Name of Property Owner(s) (Please Print) -, TC) I1na F e ' i e <br />Address of Property Owner(s): �j tv r ) <br />Contractor(s) Name: Q� �ro N � <br />Contract Company Name: V S • :5; <br />Contractor Address: Q 1 L L-' -- Col ti , L.,c. Ca•� <br />City: 0:5Ceo I e\ I _�C/V gL56 1 ' Phone: 57V-6 <br />Current Use of Building Va CaA V — 6� nn ev% <br />(Single Family — Multi- Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction:) NvAJ - t ll"'" �.c,,�e �i �"f •,-, 5 <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: E] In -kind E] Landscape ,New E] Replacement ( not in -kind) Ej Demolition <br />(none than one bar may be checked) ` <br />Description of Proposed Work: <br />i ,.: ��. �v.n �, < t L c, Uzi ,a r{ 1 %lv �,.•, � ..», c�.. �, (o s e P eA2+ <br />E 6 IN F.1Z C)74 <br />Owner /Contractor: Fax: 7Y - 6 7� � � e-mail 4c, P 1 -_ V5 : ,•�C'rti� : Le y? - <br />(This officr d with only one designee) <br />and /or <br />_ — APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />. <br />