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Application <br />- FOR'- <br />Certificate i'cate o f 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.st osephcountyindiana.com/sjchp/index.hbnl <br />OFFICE USE ONLY»»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX—- OFFICE USE ONLY <br />Date Received -3P" a00Y Application Number <br />Past Reviews: [;ES (Date of noel Review) 2004 ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: /% Xxfl- Zoo,? <br />❑ Local Landmark Eg-tocal Historic District (Name) t&J <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: Q/ )171 ee ' Dt-. <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) 2-aI A r'0 M,4 /l 1)7 7 i <br />Address of Property Owner(s): trf� J 1� �g &)a k11- �7� 5nr 1- <br />i <br />Contractor(s) Name: P.2 -•P r PG `l np . <br />Contract Company Name: 1KAnjoirl4 UJOrIA <br />Contractor Address: 1 2A 47br. <br />� ¢e,( 2(rq- '3Q2--727'3 <br />City: &rckelcjtr P one: �7!j - 2�T3,,7. r-' <br />Current Use of Building: 5/12)P �vrt :/V. <br />/(Single Family — Multhamily — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: UA) 061 C-rct ~ <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: In-kind ❑ Landscape ❑ New aReplacement (nwt in-kind). ❑ Demolition <br />(more than one box may be checked) / <br />Description of Proposed Work: -&(,2_' (J�J/i�j Gr►d I���WS r' ��A/ A r, km <br />Owne otracto <br />nr• Fax:,7 7 7- :,2. ci Lo, e-mail _ n� Ccv s 640 be d . n- � <br />(This office <br />will correspond with only omme designee) <br />and/or <br />— APPLICATIONREQLUREMENTSA.RE LISTED ONREVERSE SIDE — <br />