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`�1:pD �O� <br />Application <br />- FOR - <br />Certi f irate b f Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd, South Bend, Indiana 46601 <br />Mailing Addres County-City Building, South Bend, Indiana 46601 <br />s: <br />Phone: 574- 235-9798 • Fax. 574235 -9578 • Emi :SWa9C®cost*)seph.inus <br />Website: http:// wwwstjoseph counVindiana.com /sjchp /index html <br />OFFICE USE ONLY > » »> DO NOT COMPLETE ANYENIRIES CONTtINED INTHIS BOX » »» OFFICE USE ONLY <br />Date Received / �1 •� X 008 Application Number .!6 0 O - D <br />Past Reviews: 1 fES (Dateo/Last iWk.) <br />Staff Approval authorized by: <br />Historic Commission Review D <br />El Local Landmark <br />EI National Landmark <br />Certificate of Appropriateness: <br />Denied [] Tabled <br />Title: <br />ate: 021 C200 8 <br />[]'Local Historic District (Name) <br />National Register District (Name) <br />F1 Sent lb Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work • j �±� £ �-` b�? VA ` v 3 N <br />Street Number and treed N <br />Name of Property Owner(s): (plow Print) �' V— v <br />Address of Property O 1 Z y �, G fie. t It snN 13 � A. i � • � ` °"� LA) y ( PG l <br />Contractor(s) Name: i�>A�k��ot Gm`s <br />(prone than one box may be d WW) <br />Description of Proposed Work: - ZL ` k NCS ! /Z d� 4 f- - k�► N tS t&U ';' V) <br />` <br />1 X7 4 -��3 O �,�S <br />er /Contractor. Fax e.mail <br />( me7loo r�ond onlyonedfxiltQ� �/ <br />and /or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />Proposed Work: In -kind [] Landscape ❑ New 16 Replacement (not in -kind) ❑ Demolition <br />Phone: <br />(Single Family Multi - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: It- 0 NO t) - �\ <br />bod Frame — Brick — Stone — Steel — Concrete — Ot&r) <br />Contract Company Name: <br />Contractor Address: \ (� ( S <br />City: F t k ttiPaA 1 <br />Current Use of Building <br />/U IF CA 0 0 NO <br />