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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 A"m <br />Phone: 574-235-9798 - Fax: 574-235-9578 - Email: SBSjCHPC@co.st joseph.in us <br />Website: http://www.sgosephcounVindiana.com/s chp/indexltml <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES COMAWED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received )4 A�e .ZOd ,% Application Number c2 00 Z - D % / G <br />Past Reviews: El YES (Date of Last Review) <br />Staff Approval authorized by: <br />■ • <br />Title: <br />Historic Commission Review Date: OW et00 7 <br />(] Local Landmark [Local Historic District (Name) <br />N <br />n National Landmark [✓�'jVational Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied E] Tabled [D Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: 1 V J <br />Sumb r nd Street Namr. <br />Name of Property Owner(s): (Please Print) Pin <br />Address of Property O e <br />Contractor(s) Name: <br />Contract Company Name: ' <br />Contractor Address: <br />'< ALS <br />k <br />City:_ __SoaAk� fi.4nd Phone: <br />Current Use of Building: <br />(Single ami7y —Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: <br />(Wood Frame — Brick — Stone — Steel — Concrete —Other) <br />Proposed Work: [] In-kind E] Landscape JANew TVReplacement (not in-kind) [] Demolition <br />(vane than one box may be duxW) I IJJ <br />Description P posed Work: �`�� Xtfl l <br />A <br />Owner/Contractor: Fax: a-mailZR Lee_4(!:�ffl� A ILL <br />(This rtes rid with only one I <br />k7 I - () I and/or - <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />