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Pico W <br />MR <br />t50 <br />sssioyr��o� <br />slis' 1"11ie a Application <br />p tl�l;MO – FOR – ar ° <br />E �i3 <br />Certificate of AppropriatenessDA <br />Historic Preservation Commission of South Bend & St Joseph County <br />r 125 S. Lafayette Blvd., South Bend Indiana 46601 <br />1865 Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: SBSJCHPC@co.st joseph.lrLus <br />Website: http://stjosephcosmtyindian&com/sjchp/ <br />A Certified Local Government <br />OFFICE USE ONLY-- DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received Application Number <br />Past Reviews: YES (Dnteoft.ntR view) [51<0 <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: l- a,ve <br />Local Landmark [r Local Historic District (Name) <br />Ej National Landmark F] National Register District (Name) <br />Certificate of Appropriateness: <br />Denied n Tabled E] Sent To Committee n Approved and Issued <br />DATE <br />Address of Property for proposed work: �� IV.,rf4 Shute bi.JJ ,56,A (�tv? ,:TN <br />Ar Street Number and Strdet Name <br />Name of Property Owner(s): (Please Print) _940A d- Ar VC t <br />Address of Property Owner(s): uS W- Alar4 SW%r d)r. . <br />Contractor(s) Name: To. r• i l <br />Contract Company Name: <br />Contractor Address: <br />City:Phone: <br />Current Use of Building: 5i4 ��2 "d) <br />(Single Family JMulti-Fatuity — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: ti000t 4M{, <br />( Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: FlIn-kind ❑ Landscape ❑ New F� Replacement (not in-kind) R Demolition <br />(more than one box may be checked) 0p - l /` , <br />Description of Proposed Work: 9tMOVL A�V/MiA UM SrG 114 4kt!A re14"t lI&4 Sl�ik, <br />,A4 cvtar Oaidit 414c ticl cLAP2 Letd`ef' SrGlit r. J <br />Owner/Contractor: Fax: e-mail rV" dvh L 0, Gmr, LeM <br />(This office will correspond unth only one desi ee) <br />Xw -- 4A• ez') and/or <br />Signature cif Owner Signature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />_ - z—...;_ ....-...- _... .. <br />DescriptionofProposedW. 6rk: Reconstruct front Dorch per attached <br />drawings. Design -based on --old postcards of house (copies <br />attached); <br />Architect: <br />QxW3WJGatikt W= - Fax: <br />(Ihk office will correspond with only one deli eJ . <br />Si nature of Owner <br />e-mail: crumlishb@aol,.com _. <br />Signature of Contractor <br />APPLICATION REOUIREMENTS ARE LISTED ON REVERSE SIDE. <br />• <br />A <br />