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FA <br />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: SBSJCHPCQco.st joseph.inus <br />Website: http://www.stjosephcounVindiana.com/sjchp/index.html <br />OFFICE USE ONLY »»A» DO NOT COMPLETE ANY ENTRIES CON71tINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 01 7.00001� Application Number - 4XII 7 <br />Past Reviews: F] YES (Dote of tast Review) E] NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: �✓�X�4� d PD Q , 1 <br />Local Landmark [VJ�Local Historic District (Name) <br />National Landmark E] National Register District (Name) " u <br />Certificate of Appropriateness: <br />E] Denied E] Tabled ❑ Sent To Committee E] Approved and Issued <br />Address of Property for proposed work: Soo 'C->• I tN4c0ii Hifi" 1 <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) 4V1ri JcL F'W'/fO <br />Address of Property Owner(s):" To i cx—rm A'fm <br />DATE <br />Contractor(s) Name: 1"6-1PL .- <br />Contract Company Name: Cum Pi.f­ Tf e -f- .3 C) <br />Contractor Address: <br />City: Phone: 574. 232 • 7-7op <br />Current Use of Building: 51k& f— Fi4-tit�'� <br />(Single Family - Multi -Family - Commercial - Government - Industrial -Vacant - etc.) <br />Type of Building Construction: K/6" FP- ' ,'- <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: F] In-kind [Landscape F1 New E] Replacement (not in-kind) Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: 4t4a,,�i, o* r{art -4er rVa-rt1A 1' P t nF, TPS S <br />�3 �c.st SPIirJci?� t F,e1 'AC'0- or. -w bt= f i- t%vsfi- orf ntc- <br />6n74" lwl Prm ; r+ m &P -o- z lmoi- 41-t.)r4/k x m,, /ch" -d fe&rm'1 a,r— ylr" . <br />&P -Zi H cw D Eu ©,>vxs rv-o& wh4,.xv rw�uc. <br />Owner/Contractor. Fax: 5Z+ 1 • e-mail 1 Wld P RUC - :LLA -r0 is :St&ti. c: <br />(This office well correspond with only one designee) . <br />(�&o1 •344.4t12)_ and/or 'i Nou-e44AI Z� to - 11 Z <br />LEu.- <br />- — APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />