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It <br />Application <br />- FOR - <br />Certificate of Approp riateness <br />Historic Preservation Commission of South Bend & St_ Joseph County <br />125.5. Lafayette Blvd., South Fiend, Indiana. 46601 <br />Mailing Addn�s: County -City Building, South Bend, Indiana 46601 <br />Phone: 574235.9798 • F=574-235-9578 • PmaL SBS - IPC@scost joseph.in.us <br />Website: http: / /wwwst osephcountyindi mxom /s chp /index htnil <br />OFFICE USE ONLY » ­ NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOY » »» OFFICE USE ONLY <br />Date Received 3 I J Application Number � �j - a 7 Q <br />Past Reviews: ❑ YES (Vak of Las KMrv) ❑ NO <br />Staff Approval authorized by: Tithe: <br />Historic Commission Review Date: <br />F1 Local Landmark E] Local Historic District (Name) <br />❑ National Landmark E] National Register District (R"ame) <br />Certificate of Appropriateness: <br />Denied ❑ Tabled 0 Sent To Committee Q Approved and Issued <br />VATL <br />Address of Property for proposed work: Intersection o Lafayette and North S hore <br />Stmt Numberand Street Name <br />Name of Property Owner(s): (ms Print) City of South Bend <br />Address of Property Owner(s): 227 West Jefferson, Room 1316, South Bend IN 46601 <br />Contractor(s) Name: Not Selected - Project Bid opening August 24, 2009 <br />Contract. Company Name: <br />Contractor Address: <br />Cit <br />Phone: <br />Current Use of Building: Empty lot along the St. Joseph River <br />(Sinete FamiPy - Mu Fandly Cer*mrercia.T - Camnanent - Irdustruri - Vacant - etc.) <br />Type of Building Construction: Steel Cabinet <br />(Wuxi Frame - Yrkk - Sim - Swl - Concrete - Other) <br />Proposed 'Mork: Q In -kind [j Landscape IN] New ❑ Replacement (rot in- ki 4) <br />EJ <br />Demolition <br />(wore tium ors box tray he eh.^cked) <br />Description of Proposed Work: Please see attached paper work. <br />Owmer /Contractor: Fax: 574- 235 -9171 e -mail phenthor(a),southbendin.gov <br />(Ties once �7ii aFreespnrsf i['it1T anhf a� desigrux} <br />Patrick Henthorn (p) 574- 235 -5998 and/or <br />— APPLICATION REQtiIREMENTSARE LISTED ONREVERSE SIDE — <br />