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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 SBSJCHPCQco.st josephinus <br />Website: http://www.sgosephcoungindiart&com/s chp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONMWED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received o2 -,G "07 Application Number.9 0 O y _ 0040 6 <br />Past Reviews: ❑ YES (Date of last Review) <br />Staff Approval authorized by: <br />❑ NO <br />Title: <br />Historic Commission Review Date: .Z - a4- -?#V7 <br />❑ Local Landmark ® Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />SE GORNe.it OF <br />Address of Property for proposed work: SW CottatEe? of Aticm- 1 s Noe7w Soon f_ Ao -4ELA Qt ✓*/15rnE <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) CITY of $0crrt4 <br />Address of Property Owner(s): /3/4 CouNTr Co-rr Buy&,b#Ai& 56&4" -9&&rb . /tl1 4(,6o( <br />Contractor(s) Name: `7-43-D <br />Contract Company Name: TBS <br />Contractor Address: %aZ� <br />City: Phone: <br />Current Use of Building- A11A - NO BUILDING$ /,Vv0lyE7j <br />(Sin le Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: N 7A <br />c <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: ❑ In-kind ❑ Landscape M New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: /4ISro9tLA7'/0.V Of A&A) 480 SANi?ARJ- 56W&Z <br />IP! NDE2 ?NE ST. JaSEPN AVI-4 rROM ANGELA AMJD "9T9 Saae,c <br />'Tv AN(sELA lull /CiV,,6ZS/7>/C <br />Owner/Contractor: Fax: .235-9171 e-mail iArIW 5oudA%Wai� . jov <br />(This office will correspond with only one designee) <br />c3AS0N and/or <br />— APPLICATIONREQUIREMEWS ARE LISTED ON REVERSE SIDE — <br />