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0 <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: 574-235-9798 • Fax: 574-235-9578 • EmaiL• SBSJCHPC@co.st josephin.us <br />Website: http://www.sgosephcoungindiana.com/sjchp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX--- OFFICE USE ONLY <br />Date Received 05.0b.200'b Application Number a o o 8. o6-a5A <br />Past Reviews: F] YES (Date of Last review) Ej NO <br />Staff Approval authorized by: Title: <br />no <br />Historic Commission Review Date: o" �� -V " j orb'�j,E]Local Landmark Qv Local Historic District (Name) C'W❑ National Landmark E] National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied E] Tabled E] Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work:_U2_0 NLV1 n i 1 S . <br />(( Street Number and Street Name <br />Name of Property Owner(s): (Please Print) '[' Uino_ -Pr 1'-; U �-cn o . n <br />Address of Property Owner(s): � � of 1F'_I''1(in ✓� 1)) ���(,( i'�� � � � Q 1 1A <br />Contractor(s) Name: _ Apra.ii d0L &bei _ <br />Contract Company Name: kftA 'VIAOL#dIeLk <br />Contractor Address: 1 2C o i -Vin i'Y 'I _;29 - biA_ c,> <br />Phone:��- c�3Li ��o`Zy <br />Current Use of Building: '51 q e. ?�L'm 119 <br />(Single Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: WOd V� 6k'Lff\1'(\U.m Gil ti n <br />(Wood Frame - Brick - Stone - Steel - Conc e - Other) <br />Proposed Work: F] In-kind Ej Landscape ❑ New Replacement (not in-kind) MDemolition <br />(more than one box may be checked) <br />Description of Proposed Work: Ptd I tit, '_s 4W 'ble Y - <br />i. J.I. / .7 t1 I ' 1 I! �.� /. ./ <br />• r •F'. t.►)L.i1.. t.1 / aol cum. <br />Mis office will correspond only one designee) <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />