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Application <br />- FOR - <br />Certif icate 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 • Fanail:SBSJCHPC@co.st-joseph.in.us <br />Website: http://w"«n,.sgosephcomityindiana.com/sjchp/index.htiA <br />OFFICE USE ONLY—»» DO NOT COMPLETE ANY ENTRIES CON71tINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 'iii —24 - 4jO 7 Application Number DO_7 - 0 5/LG <br />Past Reviews: ❑ YES (Date of Last Review) <br />Staff Approval authorized by: <br />❑ NO <br />Title: <br />Historic Commission Review Date: ��" -at / ` e200 7 <br />❑ Local Landmark [?'-ocal Historic District (Name)_/I f� <br />F-1NationalLandmark Ee'fiational Register District (Name) 6� <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: J " `a ri t fou Pt/ac e _>w vid 0(e <br />n p Street Number a ,Street Name <br />Name of Property Owner(s): (please Print) <br />Address of Property Owner(s): ✓Y► e "/ r <br />Contractor(s) Name: �d _3e dp l..%G� c� <br />Contract Company Name: <br />Contractor Address: <br />City: Phone: <br />Current Use of Building: 1 t' fP Q YY!" l 4 <br />Single Family —Multi -Family —Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: ,#7 1Y Lyn; v4 1 Po S i l� <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: C ?� ❑ In-kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) _;� /_ <br />Description of Proposed Work: I e ml),Ae i�.`2t�✓Y),►'1; LoAe ri <br />r -e pI a 0_1 ro©-F . <br />0 MW <br />r_P it/f lf die ago --:0 YD <br />�Pcl- <br />C�.s <br />ne ontractor: Fax: e-mail C_kGt rtes— rDSenb, <br />-em ya hoo <br />ff.111 <br />correspond with only one designee) "j V I <br />and/or <br />— APPLICA7IONREQ1HREMENTS ARE LISTED ON REVERSE SIDE — _ <br />