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Application <br />- FOR - <br />Certificate of Appropilateliess <br />I I istoric Presemation Commission of South Bend & Stjoseph County <br />125 IS, L-afayette Blvd, South Bend, Indiana 40 )l <br />M address: County -City Buildin South lke nd Indiana =16601 <br />Phone-574-115-97 Fax: 574-r <br />W hup./ /www.stiosephcoLintviiictia.tiii,coiii/s <br />OMCE USE ONLY>>­­ DO NOT'CO.411-ILE7'1-..ANY'FiV.]'[111;5 COIVIAINFI) IN MIS BOX >>>>>> OFFICLAISEONLY <br />Date Received-... /-- a 20,09 Application Number <br />Past Reviews: Lt;�41.s (Dah "W - - - - --------- I ... ......... . - . ...... . .. ....... ...... NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date. 7 440U-f a" 9 <br />1.0cal Landmark F—Vrocal Historic District (,yamr) <br />. . . . ............... . .. .... <br />National Landmark F, 'ationil Register District <br />CCAIRUILL' of Appropriateness: <br />Deeded E] Tabled ] Sent To Committee E] Approved and Issued <br />DAFF' <br />Address of Property for proposed work:- k Avt . .......... <br />Stree, Nhum be- andSuee'lMar <br />Fame of Property Owner(s): (m­ �;i P, <br />Address of Property Owner(s): 7/0 (tar C- <br />Contractor(s) Name: <br />. ,__S .1 <br />Contract ConipinyName: f&P1A.C_e4Vf4 <br />Conti Address: PO \4_13 0 � <br />City: m, tvk a 0 - Phone: <br />1 — I <br />Current Use ot'Building: <br />(Sin,0e <br />Type of Building Construction: <br />(Woof! Frame 13r;" .k -5!,ljw - S!eel •.- Con rele. ­ 001erl <br />Proposed NVork: In-kind 0 Landscape � New F] Replacement (not in-br-) Demolition <br />(f"A mrk ?i:;I? vlw h,.l N di( led) <br />Description of Proposed VVork: P_e-(urk4S resc �o 1--ef <br />... . ... .... <br />r '0" <br />. . .... . ........... . <br />Okk Fax: _5_mS3LJ�?_.3T e-mail <br />... ........ .... .... . . <br />a n /o r ------- <br />. . . ... ........... ......... ..... . <br />APPLIC.17YON REQUIREVIENTS ARE' LISTED ON REVTRSE SIDE' — <br />