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J <br />Application <br />-FOR- <br />Cert i fi cate of Appropriateness <br />Historic Preservation Commission of South Bend & St..bseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />M ai I i n g A d d cess: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Ernafl:SBSjC1VC@co.st-josephin.us <br />Website: http://www.sqosephcountyindiana.com/sjdip/index.htnl <br />OFFICE USE ONLY --DO NOT COMPLETE ANY ENTRIES CONIAINED1NTHIS BOX "'> OFFICE USE ONLY <br />Date Received a,��ci�u,E>�Gb, Application Number ol00 L-10olS <br />Past Reviews: ❑ YES (Date of last Review) F-1 NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: / l xAd14WC-4- -21010 7 <br />Local Landmark vocal Historic District (Name) <br />National Landmark [ o ational Register District (Name) <br />Certificateof Appropriateness: <br />F1 Denied E]Tabled []Sent To Committee []Approved and Issued <br />DATE <br />Address of Property for proposed work: $ F6 regio- A-aZ n4A_0-- <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) -F- 12ml, <br />Address of Property Owner(s):I/l <br />,, �1 Rb ^ee/4},-k <br />- / ,4 tJ�ri r� <br />ContractorAs) Name: k � Fes,L�w?e.. '/d to �j ki e-2 <br />Contract Company Name: -- g,;. FPSL c;17— [AIA <br />Contractor Address: <br />City: A)a Yi ��m nee Phone: .5'7;'L/ 4CD ;) <br />Current Use of Building: �r�f �u) <br />(Single mily —Multi -Family — Gbmmercial — Government —Industrial —Vacant —etc.) <br />TypeofBuilding Construction:Dec&-,i47;tp ,7G;-2-1 <br />(Wood Frame — Brick — Stone — Steel — Concrete — Othetlo, <br />Proposed Work: [:] In-kind []Landscape ®'New [Replacement (not in-kind) E] Demolition <br />(more than one box may be checked) (-P p DAY +i .I / <br />Description of Proposed Work: Ve, IA 101 a 1J, a) d t, welel C_ <br />4 G i: 0-,g- H a rn�-,-i/`/ rr ! t���, t' ✓J t7jt r C 1 J l � <br />'fu all Ali? S V e P <br />Owner/Contractor: Fax: e-mail el hIe K (-% oW <br />(This office un7i correspond with only one designee) <br />.and/or <br />—APPLICATION REQUIREMENTSARE LISTED ON REVERSE SIDE — <br />