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a <br />Application <br />-FOR- <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Wayette Blvd., South Bend, Indiana 46601 <br />Mailing Address:County City Building, South Bend, Indiana 466(11 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email:- SBSJCHPC@co.st joseph.inus <br />Website: http://www.sgosephcountyindiana.com/sjchp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 7W4,V.100 8 Application Number ')_ O 0 ey - (f)'5 -o 7 <br />Past Reviews: n YES (Date of Last Review) <br />Staff Approval authorized by: <br />0 e <br />Title: <br />Historic Commission Review Date: 200'? <br />[] Local Landmark Local Historic District (Name) <br />[] National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />R Denied E] Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />VO t7 <br />Name of Property Owner(s): (Please Print) PC, 10 <br />Address of Property Own <br />er(s): <br />/c/ <br />Contractor(s) Name: %i� 7 <br />Contract Company Name:. <br />Contractor Address: <br />P4s, k Ave. <br />Street Num r and Street Name <br />city. Phone: <br />Current Use of Building:Ile a K4 i�1 W <br />(Sing ! ily - Multi -Family - Cotm a- al - Governmet - Industrial- Vacant - etc.) <br />Type of Building Construction: W'^�{� <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: ❑ In-kind [] Landscape 0New Ej Replacement (not in-kind) (] Demolition <br />(more Own one box may be chtxked) ii <br />Description of Proposed Work: 44r �.. (( el a4 11 A_ 4-t,,.4- <br />rc�P Ho(a S pP r- %a� �a J i s Go -t ro +M l $ t� <br />Owner/Contractor: Fax:0,-/: e-mail REiL44 td t ri Int cr,� S EI D�ae,� <br />ffi Tt mdwithonly deli zee A-1 S-ror-Trf.S Coiv'S7"e[ L-7_10 I we4 B L.V -r7rE r�_j rlC <br />„¢„ ,e}.tta BEt�' /,•t a �lf� ,moo �G./n� �. A � f-fr�vS,E <br />. T and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />