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q.4 22'�1-2- <br />OIa50 <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: 57¢235-9798 • Fax: 574235-9578 • Email: SBSJCHPC@co.st josephin.us <br />Website: http://www.sgosephcountyindiam.com/sjchp/index.html <br />OFFICE USE ON1,Y »»» DO NOT COMPLETE ANY ENTRIES CONVIINEDXVTHISS BOX""" O ICE USE ONLY <br />Date Received lib•��. Q-00(?) Application Number - � V - ODE� <br />Past Reviews: [2/YES (Date of Last Review) <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />3 -Mdkzi 02 Do '? ❑ NO <br />[Local Landmark ❑ Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />Title: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: L,2 2- 9 G. /n)a.,4, k - & n <br />Street Number andName <br />Name of Property Owner(s): (Please Print) .�, `r /�c���pr� :n �to 'I, i <br />Address of Property Owner(s): <br />Contractor(s) Name: �� (1517W. <br />Contract Company Name: etq (I C_9 -r -/v _?L to ti )�1 "t� <br />Contractor Address: / ; r 6r- <br />city: <br />r_City: Sec) u ON Rp,.,N Phone: <br />Current Use of Building: ----51" I,. <br />(Single Family - Mult3amily - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: Mtne9r/ <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: ❑ In-kind ❑ Landscape ❑ New ;K Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: _90d <br />0 / ctr,n f l Wc2oje�Qr .�• i. P „ u9 H �.n ci1 S <br />",'-it. _sL74. C12'-d.'jej 1.fP��� <br />Owner/Contractor: F 'h' _ e-mail h r- 1 t+Y- <br />(This office d 'th ly ne designee `- <br />-7 and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — - <br />