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1k <br />Application <br />- FOR - <br />Ce,dificate of App optiateness <br />Historic Preservation Commission of South Bend &- St. oseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46001 <br />Mailinry Address: County -City 11-1,4;,, C—al, Bend, T,,,I;,— AAAM <br />Phone:574-2-B-9798 Email: SBSJC-IIPC(el)co,,,,I-jo�pti,itius <br />Welnitt- littp.-//wlv'i,,,.stjo.%.Tlicountyiiidiana,com/clip/ index. litml <br />OFFICE LISE ONIY>>>>>> DO NOT COMPLETE ANY ENIRIESCOML-1 INED IN 77113 BOX >>>>>>OFFICE USE ONLY <br />Date Received Application Number ., -'f 4' <br />Past Reviews: S (Uzle,rf Us f Rmn'rw) 2,6 03 <br />j NO <br />Staff Approval authorized by: Title: <br />Historic Cortirnission Review Date: I 0 'y <br />Local Landmark ['`Local Historic District (Narne) <br />National L; <br />andmark F-1 National Register District (minje) <br />Certificate of Appropriateness: <br />Ej Denied E] Tabled F] Sent To Corninittee E] Approved and Issued <br />DATE, <br />Address <br />, of Propertyr-. t' <br />proposed 'N�t * <br />Name of Property Owner(s): (Pimse print) <br />Address of Property Owner(s). <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />Sheet Nuriberawl Rreq Name <br />............. .. <br />City: Phone: <br />Current Use of Building - <br />Type of Building Construction: <br />Wood frame -- 9 tick - Stone - Steel - Con crete - Oth "r) <br />Proposed Work: In-kind Ej Landscape D New F Replacement (r ot in-kinfl) [j- Demolition <br />/Proposed <br />thin ane too my be d:Aed) <br />Description of Proposed Work: <br />Owner/contractor- Fax: e-mail <br />0" !�ti offirty will airre"pond With only one dit;ignee) <br />......... . . . . . .......... .. . . ...... . ...... . and/or <br />— APPLICATION REQUIREMENTS ARE LISFED ON REVERSE SIDE — <br />