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ti <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: SBSJCHPC@co.st-joseph.in.us <br />Website: http:// www. sgosephcountyindiana .com /sjchp /index.hhid <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received JW " ff 1 2 011) 8 Application Number aIZ6 Z - M05 <br />Past Reviews: [►�'Y ES (Date of Last Review) F NO <br />Staff Approval authorized by: n Title: <br />Historic Commission Review Date: f� ,l u 0 0�0 0 <br />Local Landmark � Local Historic District (Name) [ � e . <br />National Landmark 1X National Register District (Name) <br />Certificate of Appropriateness: <br />Denied 0 Tabled ❑ Sent To Committee 1 Approved and Issued <br />DATE <br />Address of Property for proposed work. - 7(0 l o cw - � A <br />�? <br />Street Number and Street Name of Property Owner(s) (Please Print) G 20 r c) e 5 �Yl �(B �e <br />Address of Property Owner(s): 710 rczz L- '4ve . <br />Contractor(s) Name: <br />Contract Company Name: SV54e mS 2rVtGi�iJt��^( L{c( , <br />Contractor Address: / / X 2304 - <br />City: kA (aota- F j N1 4900 Phone: Z 6q - -345' g2 <br />Current Use of Building: Si "ei le- 4W . /y <br />(Single Family - Multi - Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: W0 c -( sz <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: In -kind [] Landscape [] New E] Replacement ( not in -kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: ke4 r 6ts'� jl2s r� /CCf1'o�► jSh' -7y� G•1iv.n�Ot�l <br />So s A e 5 r trvi� s bz ttil re e iv. �vt�c�t bal d o r t t3v� � eye mod( o c� r <br />0 t ( rk-o,eg C'jip bL S - t ra A. 4a 'a M air- <br />Owner /Contractor: Fax: S74 6 9 / J T7 e -mail 0 M14 e-r4- P neC <br />(This office will correspond with only one designee) <br />q NT'V �itoG� -r � and /or <br />a <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />