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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.in.us <br />Website: http: / /www.sijosephcounVindiana.mm /s chp /indexhtm1 <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received,- Application Number 56 OO 7 - d jD G di <br />Past Reviews: F ITS (Date of Last Review) [] NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: 020 0 200 1 nn nn <br />M Local Landmark [ 2oca1 Historic istrict (lvame) � ZM44 xJ <br />Fj National Landmark F1 National Register District (Name) <br />Certificate of Appropriateness: <br />Denied E] Tabled f__j Sent To Committee F� Approved and Issued <br />DATE <br />Address of Property for proposed work: q3r�� <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) C "17 <br />tom' - ]IKIC..- <br />Address of Property Owner(s): �• ���` >>C ���'r� = SS"t-4 �Idb IKi `t / (dl a "t <br />Contractor(s) Name: ktr -l' ITS TtF,E3 ) 4s <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Phone: <br />Current Use of Building: vfTC.PrT-dr <br />(Single Family - Multi - Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: QorTJ Ar` er <br />( Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: n In -kind E] Landscape n New E] Replacement (not in -kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: <br />Owner /Contractor: Fax: a3,4 - 1 17 1 e -mail .CP4 <br />(This office will correspond with only one designee) <br />APPLICATION REQUIREMENT'S ARE LISTED ON REVERSE SIDE — <br />