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f <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 />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: SBSJCHPCLco.st joseph.in.us <br />Website: http://www.stjosephcountyindiana.com/sjchp/index.html <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received '1Ii & -ArJa q- Application Number a O Z - ��� y .4 <br />Past Reviews: F� YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by:Title: <br />Historic Commission Review Date: 45-d& 4w 07 00 7 <br />Local Landmark �ocal Historic District (Name) <br />National Landmark [:] National Register District (Name) U <br />Certificate of Appropriateness: <br />E] Denied E] Tabled E] Sent To Committee R Approved and Issued <br />DATE <br />Address of Property for proposed work: rS C <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) %J046n Y r i l!a /I lat),j o <br />Address of Property Owner(s): )-r . <br />Contractors) Name: djulck- 'We c ;o r <br />Contract Company Name: S,�e_aga-r <br />Contractor Address: <br />City: %Z1S/La Phone: 913 031 <br />Current Use of Building: .s/;?e{ /e )C;r- M11 lu <br />(Single"Yalmily -Multi-Family - ComJmercial - Government - Industrial - Vacant -etc.) <br />Type of Building Construction: &)Oo d t diJ�L�Yat <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: © In-kind Landscape [] New Ej Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) Q <br />Description of Proposed Work: 41d 10i`lvtG [v3 <br />bz-c xan-4 ,~ E�rts -� '/- Aa tie ixt✓rs�' / <br />^ I� Ko Gc1ooD <br />%re-�,p.� are., `t ,`d s4e r rn� rep kee-YYC-014-4 t 7�21X/c�ttJ <br />j ms.,o r i� sAs �lY 'Xet rrLOS "Ce - c f <br />Owner/Contractor: Fax: �� ' a 7 e-mail -i-ea 11`4 r',C D -00'o r G.ia Ape). <br />(This office will com!swnd with only one desionce) V <br />o.l�►'�i-lam (:CL/�9w and/or 1�7ri pct �iz-U <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />