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M <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 AAA—..- Southing;T.Ala"a ".Ani <br />Phone: 574-235-9796 - Far. 574 -Z35 -M Entail: sB%CHPC@cost+nephJnus <br />Website: htV//wwws tyhdWMcom/SjchP/huiexhtml <br />OMCE L1SEONLY*.­,"3, DO NOT COMPLETEANYEN7RIES CONZUNM jNnUSBOX :-":o)-.v OFFICE USE ONLY <br />Date Received 4 UAW -2004f Application Number _4 0 0 3 . 03P 4 <br />Past Reviews: 0165 Cm*,f Lo nNO <br />Staff Approval authorized by: Tide: <br />Historic commission Review Date: 7 7x4"4 W& 3 <br />( 1:=- a Landmark 0 Local Historic District (Nam) <br />0 National Landmark 0 National Register District Ovam) <br />Certificate of Appropriateness: <br />0 Denied [] lkbled [] Sent 1b Committee [] Approved and Issued <br />VAU <br />Address of Property for proposed work..- 3.2 q Wash*i nab oti <br />Sftw Numb& and Stred Nam <br />Nam of Property Owner(s): (Row Print) 1.4al-k. A. Alq.Alan /Veal <br />Address of Property Owner(s): <br />Contractor(s) Name: sw� DO <br />Contract Company N r ce_s <br />Contractor Address: LIZ 31 .5. 2�' A/ -Ar,, A <br />City: GnXngak ' ZW Phone: <br />. . <br />Current Use of Building:S�tj L ho rn e- <br />(S*L- Fmay- hWgrway - cmm=W m'Gwnwmt - [ndwkW - Va=t - dr.) <br />lype of Building Construction: Sivccv UVWOO V '#Mb9Pi)t <br />OW Frame - Orld Stone- Stet - Omcmk - OtW <br />Proposed Work: In-kind Landscape VNew Replacement (not m-und) ❑ Demolition <br />Genre dm am box, may be derW <br />d&LS41me qa4an shtd <br />Description of Proposed Work: -Re F Q12ex. 12rey OU <br />insar of pep oaeiL itror <br />ddr <br />Or.9 Of home-, guo- O1nP'h <br />_f1_CaMtr(2r1.Q_ &nd drau)rn smf- <br />Owner/Con tnkqor. F=1 e-mail <br />and/or <br />APPUMTrON REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />-4 <br />