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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• SBSJCI PC®co.st joseph.in us <br />Website: http://www.stjosephcoun4,indiana.com/sjchp/index.html <br />OFFICE USE ONLY--- DO NOT COMPLETE ANY ENTRIES CONRLNED IN THIS BOX --—OFFICE USE ONLY <br />Date Received I? &— mex d oo 8 Application Number q 0 0 8 - /00 8 <br />Past Reviews: R YES (Date of Lasf Review) J -15-2-00(a F� NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: ow /W&40) 01001 n <br />Local Landmark Ellocal Historic District (Name) /_, <br />National Landmark oNational Register District (Name) <br />Certificate of Appropriateness: <br />Denied F� Tabled E] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: f 1 t FOre6+ Ai%e m ue, <br />Street umb r and Street Name <br />Name of Property Owner(s): (Please Print) Ka re n A � V)S CiY � (!)'►� SCD " <br />Address of Property Owner(s): '711 `F' ore,5+ /�V:(�VI jb <br />Contractor(s) Name: BVI Y1� lY 0j &r <br />Contract Company Name: c(,�S I ()Yr "1 Sttel �)e,cJ 1(� i� <br />Contractor Address: 11'(05S 000, . /) <br />City: li.i'16W -a h a j1 4 o 5 (6 Phone: 2-&6 '- Rog- 112-k2 <br />Current Use of Building: 1I e %i h'1 ! <br />(Sifig Family -- Multi-FamilyACommercial - Government - Industrial - Vacant - etc.) <br />VV <br />Type of Building Construction: wood Frame, <br />(Wood Frame – Brick – Stone – Steel – Concrete – Other) <br />Proposed Work: E]In-kind F-] Landscape D4New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: S t Aff a Ch ed <br />Owner/Contractor: Fax: 57+-232-;- 11 1 1 e-mail <br />(This offce will correspond with only one designee) <br />Kai' ) A l Yi S I G and/or I! m SCCA + <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />