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r� <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: 574235-9798 • Fax: 574-235-9578 • Email: SBSJCHPC@co.st joseph.in us <br />Website: http://wwwst osephcountymdiana.com/s chp/mdex.html <br />OFFICE USE ONLY »»/j» DO NOT COMPLETE ANY ENTRIES CONTIMINED THIS <br />{BBOX >>>>>> OFFICE USE ONLY <br />Date Received 05• � d-'..L�0� Application Number �Q o b_ O" t� <br />Past Reviews: ❑ YES (Date of Inst xeaiew) <br />Staff Approval authorized by: <br />Title: <br />• <br />Historic Commission Review Date: �. t <br />[] Local Landmark [Local Historic District (Name)�yv� <br />National Landmark F} National Register District (Name) <br />Certificate of Appropriateness: <br />n Denied E] Tabled [] Sent To Committee n Approved and Issued <br />DATE <br />Address of Property for proposed work: [b (_ 1 I� L :_ 'c::5MF4T <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) Ct-rq C5F 54r -v -JT14 <br />Address of Property Owner (s): IF)CO C C5_ -t tT`I <br />Contractor(s) Name: K", 1 1T)F=V.1T1 Fri Ik-T- _T_H t.:` _1 E -AE -r <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Phone: <br />Current Use of Building. iiflt i� t�t"i' <br />(Single Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: \^--Iocj� <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: n In-kind [:] Landscape E] New [( Replacement (not in-kind) E] Demolition <br />(more than one box may be cheaW) <br />Description of Proposed Work: <br />Owner/Contractor: Fax: Q35__9L0Ci_' e-mail G��<�" �C]tstti l►�1•( ( <br />('17 is office will correspond with only one designee) <br />Liz- �,AAr i�, u-1 and/or —TA-1✓l W <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />