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6 <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 4tAnl <br />Phone: 574-235-9798 • Fax: 574-235-%78 Email: SBSjCHPC@co.st joseph.in.us <br />Website: http//www.sqosephcoun"diana.com/sgchp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received .S�dr�-aa a -cc -1 Application Number o�4O'7 - l 96 SA <br />Past Reviews: [B"OTS (Date oftast Reviao) [] NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: A007 (Q <br />E� /,�j} Landmark �ocai Historic District (Name) (.:�4at !� <br />M National Landmark [PlI ational Register District (Name) <br />Certificate of Appropriateness: <br />C] Denied ❑ Tabled ❑ Sent To Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />Name of Property Owner(s): (Please Print) <br />710 Pa.,r k Ike. <br />Stmt Number and Street Name <br />GEor?_67F_S C.Nor 2LE <br />Address of Property Owner(s): 7 ( 6 Po r�! A\0_. <br />Contractor(s) Name: R(CI1IR0 C(1Aj`F1.F_ <br />Contract Company Name: H © M P C r_rm c - <br />Contractor Address: M 2( NtA b Ou. r (ZaA'( <br />City: 00 WA tRC l M t Phone: 574 220 447S - <br />Current Use of Building:Si f',Ih_ kA -j4 <br />(Single Family – M00-4mily – Commercial – Government – Industrial – Vacant – etc.) <br />Type of Building Construction: Node( � lqwmp <br />(Wood Frame – Brick – Stone – Steel – Concrete – Other) <br />Proposed Work: [] Ln -kind n Landscape n New [] Replacement (not in-kind) n Demolition <br />(more than one box may be chucked) <br />Description of Proposed Work: For Co k4 P �lve lot Wo O.S� <br />eeghra+,o v-, &� 01K4, Crit-'aokv rantmss 1k b are"X_d ©Wgs root"' <br />�C¢wnc+.,,� r ivir,otmw lccsres ted art moors w,'Kdow Ajtx <br />r, - <br />ftwUt'v, Gvi`kctpw l`Gv,: CA UA�wt,t;,r 41 se r+i c(a cab(e h t� tirt?�oGn w�} <br />Owneri'Cu., 9,.. Fax: W4 C3 j 5`r95e-mail Gi AEt &P Pi <br />(This offixetd with ant tme dcssgtter) <br />�'1 � and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />