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Application <br />-- FOR - <br />Certificate of Appropriateliess <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46001 <br />ltlailin; Address: Coun City Building Sautlt 13EL, ,Indiana �IiCiC}1 <br />Phone -5 -74 -?-35-9798 • Fax: 574-135-937((8 • Email: SFISJC11PCc co.st-jo-�--pli.in.us <br />Website:litt}YJ/W'VV.stinGephcoLttltyinclieinxl.comjsjchp/i.tidex.httiiI <br />OFFICE, USE ONLY »»» DO NUT COA•IPLETE ANT ElstMES C(7 4 MINED IN THIS BOX >>>>>> OFFICE USE ONLY <br />Date Received_ bl'J 't ,100 % Application Number c 2 ,00 % - 4 914 A <br />Past Reviews: C] YES (2?,ueofl,z=t <br />Staff Approval authorized by: <br />R NO <br />Title: <br />Historic Commission Review Date: 1�3"dE o) d OC? 7 <br />Local Landmark Olocai Historic District ('lame) <br />LJ National Landinarlc F-� National Register District (Fame) <br />Certificate or Appropriateness: <br />iI Denied n Tabled ❑ Sent To Committee []'Approved Lind Issued <br />Address of Property for proposed work: <br />Narne of Property Owner(s): (Pk -.,5r Print) <br />Address of Property Owner(s): <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City: <br />S! reel :' umberand Ctreel 2�fc7tt:i'(` <br />WW1._. .... _.._ a._.. �_t� j <br />} (-) x t FLS. i Y- 4�y, r- . <br />Phone.: <br />Current Use of Building- es-, (- "'u <br />(Sitgle Family- iiu i -Family- C:cmmarrial - Gnxriti eI}ml _ da,;lfiat - Vacant -Or.) <br />'Type of Building Construction: <br />(VV'Ood Franc - firkk - S"eme - Stee2 - Ccncr.tr - 0t1;•r; <br />Proposed Work: ❑ In-kind E]Landscape, [ZNew R Replacement (iict i,r-ki;;:i) R Demolition <br />(inor,• t1,m 41nie taxa iwy 1v chrkrxi) <br />r <br />Description of Proposed Work- <br />Owner/Contractor: <br />ork <br />+ <br />OwneriContractor: Fax: �'it 4 - �-`t �d - (e �-"t a -snail +e'A -amt, <br />Ir.�awith <br />h. <br />{! o€rs;r a=.22 ct'rrKF� r:d << .r� m: <br />.h� One d; si,;�r;3z) <br />and/or ' � � �` l;�'x •i . ��� .t, �> <br />- APPLICATION REQUIRErI. EN7.S ARE LISTED ON REVERSIo- SIDE — <br />