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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 />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: SBSJCHPC@co.st joseph.inus <br />Website: http://www.st osephcountyindiana.com/sjchp/index.html <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONJAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received X07 -7007 Application Number--!? Z - 091-2%8 <br />Past Reviews: F� YES (Date of last Review) <br />Staff Approval authorized by: <br />n NO <br />Title: <br />Historic Commission Review Date: I/est 7007 <br />M Local Landmark . Local Historic District (Name) <br />National Landmark National Register District (Name) O <br />Certificate of Appropriateness: <br />E] Denied E] Tabled E] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />Street Number and St t Name <br />Name of Property Owner(s): (Please Print) V V- ; G-. <br />Address of Property Owner(s): j v 47dL1'r- <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: D(OS5 YAC V-4 n <br />City: bseeo ke- ltu q(c SZo I Phone: T? 6 S71 - `7(oG S' <br />Current Use of Building- Si h031'e J�rx.Yru <br />(Single Fatniiy —Multi -Family — Commercial — Government — Industrial— Vacant —etc.) <br />Type of Building Construction: <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: F] In-kind n Landscape ® New n Replacement (not in-kind) ElDemolition <br />(more than one lox may be checW) <br />Description of Proposed Work: 1c a.�-_1_Wr ou.n 6 <br />Ob ne-'e4e- Gl eo r Nee ` V j L� n4 -r <br />Owner/Contractor: Fax: e-mail <br />(This office will conespoml with only one designee) <br />and/or - <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />