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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: SWjCHPC&o.st josephinus <br />Website: hq://www.s#osephcountyindiana.com/sjchp/index.html <br />OFFICE USE ONLY » »» DO NOT COMPLETE.ANYENTRIES. CONTtINED IN MIS BOX »»» OFFICE USE ONLY <br />Date Received 8 Application Number a O O 8- D 70 8 <br />Past Reviews: ❑ YES (Date of Lost Review) F1 NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 02 f 0%00 8 <br />E] Local Landmark R] Local Historic District (Name) sQ&Iz> <br />Ej National Landmark E] National Register District (Name) <br />Certificate of Appropriateness: <br />Denied F1 Tabled E] Sent To Committee F] Approved and Issued <br />DATE <br />Address of Property for proposed work: — " - `�� "r' _e_+A'` <br />c, Street Number and Street Name <br />Name of Property Owner(s): (Please print) b b e S o V1 <br />Address of Property Owner(s): 1 �A 0 vx <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City: P Phone: <br />Current Use of Building: (\1 <br />(Single fly — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: '�' � 0- "­- 'Q <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) - <br />Proposed Work: Fj In-kind E] Landscape ANew E] Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: n (:--6ce R -a "`1-P <br />X -0 a -V, Pa \ a�-eSS�� <br />Lo ate. - IF- N S't S, d P o u s �. <br />e -c - P tZ d`v3 �S ub vv%A.+ect <br />Owner/Contractor: Fax: - e-mail <br />(T1ds`of%iee wdl correspond with only one deagnr <br />and/or <br />— APPLICATTONREQUIROKWISARE USTID ONREVER SE SIDE — - <br />