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Application <br />-for- <br />Certificate of Appropriateness <br />k 1. <br />Historic <br />P ""a"nCommission of South Bend & St Joseph County <br />227 =Jeffersoon Blvd - RM 1123 - South Bend IN 46601-1830 <br />Phone: 219-233-9798 Fax: 219-235-9578 e-mail: histon ichianaorg <br />WO" 1,6cal G4iernmiii <br />OFFICE USeQld)5;»;>>DdN(vrCOkPtETE ANY ENTRIES CONTAINED IN THIS ROX<<<<«0F77CZVSE0MY <br />Date Received Appl ca <br />I ti.. Number: 2000- 05oYA <br />Past Reviews: YES (DAYEoFiAsTmwim NO <br />Zoning Type: Lot size <br />Staff Approval authorized by: Title: <br />Historic Coni'minion Reviewr D ; ate::' ZO 0 1 <br />National Landmark <br />National* IQistei Dist l c t!:0i.W: <br />T <br />Certificate ofAppropriatinus: <br />El DO Tabled ❑Sent To Committee <br />El <br />4prived aid Iiiiied <br />■ <br />Address offt6p;­Ay'loir"'i <br />proposed.work. 10 61 -Riverside Drive <br />City Sou t Township: Po'if.aee' <br />� <br />mark, BeudertName POwnix(s): <br />Ad;"'o*fP r*operly Ourner -1061 Riverside Drive <br />Cou"cf.or -T B <br />C, <br />ontract Company Name: ;T:DA <br />Contrictor Addreisil city: <br />C <br />ontractor's Phone No: TBA = Ownerg <br />s Phone NO: 541-912-5267. <br />Cu", t Use of Bafldiug..� <br />�-)YfkLe f4pl11v residence <br />Type Building BuIldm'_g , <br />Constrnction <br />(W"dFraw-Xrk*-Stas-Sled- Cones,. Oihr) <br />MWL <br />PipQsee - E] <br />Rpplacemeut(sai�t� <br />A ®New <br />(��"W dimtarp c <br />Form 'Also Reiauired)fL- <br />;.§A"q, <br />& MAI �, <br />P <br />,D al -le*egress <br />new at"I operab <br />roof windows.` cT,-2-Y%on-.;rear •slope.ofl-main roof and (1) on <br />chimnev side main roof as, depicted in attached drawings. <br />Archito4t: st <br />Owner/Contractor:'' ax.-'-: e-mail: c r u m l i s h b @ aol.cbin" <br />.4 <br />Architect Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />7i"y�a * and all bus(ness of dds oh1ce Is hand(ed. via &nwU andfar, with least preference to U.S Mail <br />