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Application <br />- FOR - <br />. CeMficate of Appropriateness <br />Historic Preservation Conuidalon of South Bend & St. Joseph County <br />125 & Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing ArWmacs South 'R,2"A Tntftinn 46601 <br />Phone: 5742359798 @ Fax 574-2359578 Favd- WCHF0@costjosephJnus <br />Website: http,//www.s§osephcotmVh%Uana.com/ochp/hWu-hhW <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONUMED LV THIS BOX >>>>>> OMCE USE ONLY - <br />Date Received 17(k-9- Application Number 7 <br />Past Reviews: [3 YES (U*,YL"t &L*W) <br />Staff Approval authorized by: <br />2 <br />Historic Commission Review Date: XP flg-,' 0,0 <br />M Local Landmark Blocal Historic District oveme) <br />[) National Landmark C] National Register District ovame) <br />Certificate of Appropriateness. <br />no <br />Tide. <br />E] Denied []'Tabled E] Sent 1b Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work- <br />stnxt Number and Stmt Name <br />Name of Property Owner(s); (Please Print) 0 0 <br />1:Z <br />Address of Property Owner(s): -1 <br />Contractor(s) Name: <br />Contract Company Nam: iq q <br />Contractor Address: <br />City. r Phone: <br />Current Use of Building! <br />((Single Famr�y Multi Famity - Commercial - Government - Industrial - Vaamt - etc.) <br />Type of Building Construction: <br />(wood Fra StW - St0d - COMA* - Othff) <br />Proposed Work. E] In-kind Landscape New ❑ Reollacement (not in-kind) ❑ Demolition <br />(more darn one box may be cha�l) Description of Proposed Work t r-\ <br />t) l'�C 4,Q <br />0( 1A <br />-Al-6 1. <br />1-o <br />0 r n ef <br />Okt fx)-(-�0't"i6wner/Contractor Fax: e-mail r�r f <br />C, � t,X)4-) (This office YXW"Upund uith only one designa) <br />4 b, <br />% <br />,4 cLck <br />A and/or <br />-- APPLICATION REQUIREMENTS ARE UffW ON REVERSE SIDE -- <br />