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Application <br />- FOR - <br />Certi ftcate 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: SBSjCI-1PC@cost-josephin.us <br />Website: http: / /www.sgosephcounVffidiana.com /sjchp /index.hbnl <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CONTUNED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received, 02 DD 7 Application Number a D O 7 - 4AI6 g <br />Past Reviews: ❑ YES (Date of wt Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: Q A00 <br />❑ Local Landmark ❑ Local Historic District (Name) <br />Ej National Landmark E] National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied E] Tabled E] Sent To Committee ❑ Approved and Issued <br />DATE <br />l <br />Address of Property for proposed work: ' `J� �� Li llmcl <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) 'CP � fa th(c <br />- <br />Address of Property Owner(s): 0 • RDY, <br />Contractor(s) Name: - hb - T - <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Current Use of Building: <br />Phone: <br />(Single Family — Multi- Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: \nICK3� 1"e Pt� <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: In -kind ❑ Landscape New Replacement ( not in -kind) [:] Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: ! D►i�(G, P�7�li� � ZfyL <br />134 S" 6D114 — (, �..tta. [T �-►1 �2 °�� �C� i71 "Pm A 1,IV> vl lm " <br />:fttl> -- rrFg a t' cxtc���It.U' <br />Owner /Contractor: Fax: QsaZ - 1 R1 e -mail <br />(This office will correspond with only one designee) <br />kb3W I[@CrttF3=UA gWor VPd_e2d PWEL <br />— APPLICATION REQEUREMENTS ARE LISTED ON REVERSE SIDE — <br />