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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., Soukh Bend, Indiana 46601 . <br />Mailing Address: County -City BuBding, South Bend, Indiana 46601 <br />Phone. 574-235-9798 • Fasw 574-235.9M • Email: SBSjCHPC@co st­jOseph in us <br />Website: http://www.stjosephcountlindiana com/sjchp/index htnd <br />OFFICE USE ONLY» >» > DO NOT COMPLETE ANY ENTRIES CONY nVED BV THIS BOX »»» OFFICE USE ONLY 1 <br />Date Received too 7 Application Number'Z 0 a 7 - 0 -U -9f <br />Past Reviews: ❑ YES Owe of last xeolac) <br />Stasi Approval authorized by: <br />Historic Commission Review Date: ai'ti .GA� 0, or % <br />[] Local Landmark [v]LLocal Historic District {Name) _ <br />National Landmark C1 National Register District (Name) <br />Certificate of Appropriateness: <br />■ • <br />n Denied C] Tabled [] Sent To Committee ] Approved and Issued <br />DATE <br />Address of Property for proposed work: q i'1 Minn �t j e <br />},, _ ,_, ` St Number and S�t Name i <br />Name of Property Owner(s): (Please Print) �a � ,342 1 9" <C` M 11'3 Ll LA1 t? <br />Address of Property Owner(s): y C) V1C1 a e- <br />Contractor(s) Name: Na V) 6)am+ <br />Contract Company Name: P36 b 6an:a4 <br />Contractor Address: <br />City: t>�+' � C\� rhLl I- �-1 G 15 <br />y Phone: <br />Current Use of Building. ,`�-\t;,l r.E . -�rvti� 11., �n <br />(Single Family - Multi -Family - Commcrc' <br />Government -Industrial -Vacant -etc.) <br />Type of Building Construction: woo & •��Y"Y 1 - <br />(Wood Frame - Brick - Ston - Steel - Concrete - Other) <br />Proposed Work: (] In-kind [] Landscape 0 New E] Replacement (not in-kind) (] Demolition <br />(more than on box may be checked) <br />Description of Proposed Wt ork: bL .X'��'�t2tiY1 t� t Tt l E3 n k (_..i t 18 i rxl <br />I\)- � 1 f-nA* 1 QOO n-1 4' )U 1 tC(. t n C neO C O t C"'rIL i', Q_ <br />r •2.c�.3 Ly X �P ht=t� t �1 :,.tr-�.. � fl.t] c �timk; 4:ec-4+cj_g_ <br />Owner/Contractor: Fax e-mail <br />Olds off •ice will correspond unth only one designee) C 1 1LG <br />and/or <br />-- APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE -- <br />