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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 Adess <br />dr: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 - Fax: 574-235-9578 - Email SBSJCI-IPC@co.st joseph.in.us <br />Website: hV://www.sqosqihcounqindiana.com/s chp/index.htn�l <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 6 45— % 2.00 7 Application Number g Gt7 7 - OG QS <br />Past Reviews: EIYES (Dane of Last Review) ; ®NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 20 G 7 <br />M115o'cal Landmark F1 Local Historic District (Name) <br />M National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />(] Denied ❑ Tabled [] Sent To Committee C] Approved and Issued <br />DATE <br />Address of Property for proposed work: -,!53j,7(9 <br />/ Street Number and trees Name <br />Name of Property Owner(s): (please Print) l,`1V <M ,ISN I3 VbAm) t LD n <br />Address of Property Owner(s): �J�/'-5��fO ,T�^t l P'E� 'Z1J ' <br />Contractor(s) Name: 13� ce t-t�v P�t_f C r/j P#OY6 57V -6152 <br />Contract Company Name: T do A4S 7w le ax7 ahs � lln • •ZV G . <br />Contractor Address: <br />City: Phone: <br />Current Use of Building: �S Wd e_ arL ibf-WGE <br />(Single Family - Multi -Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: F�'e-� �? ?� "rEWA/ D P'? '>-f <br />( Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: In-kind ❑ Landscape 8 New ❑ Replacement (not in-kind) [] Demolition <br />(more ttwn one box my be chrcked) <br />Description of Proposed Work- F_ -4-r" <br />AD DcTI o &/ 7-6 7#a, j"cf r S r of aF <br />I <br />Owner/Contracto . Fax: 5 77 - 7� r'! ' �! �% Z `f e-mail ft�f�PfLT$ ► "� iLc3i <br />(This d with only one ••' nae <br />and/or -�l'`� fY. <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />