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Application <br />- FOR - <br />Cernficate 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 $uiiding, South Bend, Indiana 46601 <br />Phone: 574235-9798 - Fax: 574-235-9578 - Email: SBSJCHPC@co.st joseph.inus <br />Website: hV://www.sgosephcotmgindiana.com/ochp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX >> -OFFICE OFFICE USE ONLY <br />Date Received 5, 6WO -7 Application Number g!!LI_7_ - 4 64 5-B <br />Past Reviews: E3 YES (Date of Last iwiero) NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: d O O % <br />01ocai Landmark n Local Historic District (Name) <br />[Bofiational Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />(� Denied [:] Tabled n Sent To Committee Approved and Issued <br />DATE <br />b <br />Address of Property for proposed work: <br />Street Number and StreetIme <br />Name of Property Owner(s): (please print) `6n ?, } �'pi1! �3 (�i t =( fi>�� ��-"� O lVt-71, <br />Address of Property Owner(s): <br />Contractor(s) Name: <br />Contract Company Name: vC_-G1 J''4!)t%�t _ ivr_ <br />ContractorAddress: it . , t,; 0, ��' w') 57 <br />City: M k�AA , IAi(4A � i\�t(„"h LI `�" Phone: �� S ' �i� 17 <br />Current Use of Building: <br />(Single Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: <br />r � <br />(Wand Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: [] In-kind [) Landscape [] New 'Replacement (not in-kind) E] Demolition <br />(moire tiwri one box may be choked) Iq <br />Description of Proposed Work: Y 1 a ry C'J's I L 4, 1j 6) t~' � r� yv �j 15 (� � � c.r , <br />�t�e.x7iL �reisit 4 r Q "&k_. <br />?AJgjvvgtUt T 9-C <br />dxe�� <br />Owner/Contractor: Fax. z� t 4%-A 'u, e-mail l''t1 T <br />..« <br />(This uxll � utith only grue) f <br />a� and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />