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1 <br />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 />M ai I i ng Ad dress: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: SBSJCTlPC@co.st-joseph.in.us <br />Website: http://www.sgosephcoungindiana.mm/sjchp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES COMAINED IN THIS BOX »»» OFFICE USE ONLY <br />DateReceived cit? Ci d-007 Application Number 4-0-07 - 10-29 <br />Past Reviews: ❑ YES (Date of Last Review) <br />Staff Approval authorized by: <br />R NO <br />Title: <br />Historic Commission Review Date: /9 X&1Ar"6'e_ <br />E] Local Landmark [ Coeal Historic District (Name) /7/ <br />4th <br />National Landmark EjjNational Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied E] Tabled ❑ Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: !F�) -57 Po.-eS+ AJ e ow c - <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) �V C_ -+ i/%Q/K Ra m <br />Address of Property Owner(s): 19715 ForP e-+ Ave... v 4. <br />Contractor(s) Name: ch l'u- k <br />Contract Company Name: M : Qt Fe"c. e •�, <br />Contractor Address::// f*D 9 /9 � � <br />I ,S4a 4F. lua ! n r <br />City: /l/Ct IT v1 p -e— Phone: �L/ �S�o� goo to <br />Current Use of Building: i st`r��te _,c7r•vi 0' k, <br />(Single Fa y—Multi-Family— Comkciat— Government —Industrial — Vacant —etc.) <br />Type of Building Construction: Oir&1n vrt <br />nr/ <br />► 4-A ' A (0,-" , i o v%. L2 - <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: E]In-kind ❑ Landscape (Vew []Replacement (not in-kind) ❑ Demolition <br />(more than one box be checked) <br />Description of Proposed Work: f_h (Va V01 -Y <br />Fa, ')e hAp Loo—la ti�� Aoeooe <br />Owner/Contractor: Fax: e-mail <br />(This office rvill correspond with only one designee) <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />