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Application <br />FOR - <br />CerHficate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Building, A Indiana AAAnj <br />Mailing Address: t-Oull LY LLL?;, C--- P eL , <br />Phone: 574235-9798 . Fax: 574235-9578 9 Email: SBSjGFC@co.st-joseph.in.us <br />Website: http://www.s§osephcounq4ndiana.com/sjchli/index.hbii <br />I <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONAINED IN THIS BOX >>>>>> OFFICE USE ONLY <br />Date Received_y" 200 7 Application Number .2 j2j* <br />Past Reviews: M YES (Doteoflast Review) NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 2-001 <br />M Local Landmark [Local Historic District (Name) <br />National Landmark Fj National Register District (Name) <br />Certificate of Appropriateness: <br />Denied M fabled <br />M Sent To Committee [3 Approved and Issued <br />DATE <br />Address of Property for proposed <br />work: "s <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) %64 ,i 4 yy,; t LZ /, Y1 p C, <br />Address of Property Owner(s): <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Phone: <br />Current Use of Building: <br />.SI ',r7e;.( 40 )EkW ki <br />, ;' -4, <br />(Singlenmily -Multi-Family - Commercial - Goz.Trninent - Industrial - Vacant -ctc.) <br />Type of Building Construction: <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: In-kind Ej Landscape [] New ❑ Replacement (not in-kind) [] Demolition <br />(more flum one box may be checked) <br />Description of Proposed Work: old 1-4p)2.0 .1,vt > ' eta V -e uJa4_1 <br />d <br />(4)&,,0 I_ <br />1eL4rx_ 0DO6P" 'ja-reLFt 60r L,-, IQ-- '/ j As e'l (0. If <br />4tq-0 rnx�c <br />Owner/Contractor: Fax e-mail -i-ealt"4iY'C' <br />(This office will correspoid with only one designee) <br />.J&k'v and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />