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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 josephin us <br />Website: http://www.s§osephcoungindiam.com/s chp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received o7�a Application Number <br />Past Reviews: n YES (pate of rpt Rmieso) ago <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: " oo <br />F1 Local Landmark Local Historic District (Name) CZ Al rk <br />n National Landmark <br />Certificate of Appropriateness: <br />National Register District (Name) <br />[] Denied C] Tabled [] Sent To Committee ❑ Approved and Issued <br />OATS <br />Address of Property for proposed work: �� �i Leland At'. <br />1 Street Number and Street Name <br />Name of Property Owner(s): (Please Print) .7" , J�7 Luv(,skP_-� <br />Address of Property Owner(s): <br />�+ <br />Contractor(s) Name: 7 b <br />Contract Company Name: <br />Contractor Address: <br />City: ,Phone: <br />Current Use of Building- &.L-" � Y���-��x��}-���� �Y�'-`-- <br />(Single Family — Multi -Family — Commercial — Government — Ind ustr — Vacant — etc.) <br />Type of Building Construction: Fp�w ei' <br />(Wood Frame —Brick — Stone —Steel —Concrete —Other) <br />Proposed Work: In-kind (] Landscape n New (Replacement (not ire x nd) ❑ Demolition <br />("sore titan one box may be checked) j <br />Description of Proposed Work: ChP�f l!',07 <br />Owner/Contractor. Fax: <br />(This of 5j ,will corm's nd wit only one designee) <br />J <br />-- APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />e-mail I�GCIrII�'e'C�'(?�f7C'�ICG�Zl1L' <br />and/or <br />