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08/03/2009 MON 15:11 FAX <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 -735 -9798 • Fax: 574 -235 -9578 • Emalt SBSJCHPC ®co.st joseph.in us <br />Website: http:// wwwsgosephcounVindiana .com /sjchp /index.hhrd <br />®001 /001 <br />OFFICE USE ONLY -- DO NOT COMPLETE ANY ENTRIES CON7A WED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received &Aul dM9 Application Number - 08a3 • <br />Past Reviews: RYES (Date of Last Review) M [] NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: /// 7 au? 'W1 <br />[� <br />Local Landmark 'LOCaI Historic District (Name) <br />E] National Landmark n National Register District (Name) <br />Certificate of Appropriateness: <br />Denied f__j Tabled E] Sent To Committee E] Approved and Issued <br />DATE �N <br />Address of Property for proposed work: S AO /dE� - �G Ae� <br />A Street Number and Street Name <br />Name of Property Owner(s) (Please Print) <br />Address of Property Owner(s): .5-10 ' 21 an �V� f s //V <br />Contractor(s) Name: A6 /- . _5rwe& 6 e <br />Contract Company Name: AIA <br />Contractor Address: Al <br />City /V /]fl Phone: <br />/ V/A <br />Current Use of Building: <br />(Single Fa— Mutti- Fam�Ty— Commercial— Government— Industrinl— Vacan! —etc.) <br />Q�iL/Odt` <br />Type of Building Construction: /N ,4L,4 AMAlP fUll-, 5TC!'S �EGM <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: [] In -kind ® Landscape 0 New E] Replacement ( not in - kind) E] Demolition <br />(more than one box may be checked) • :;&, M <br />Description of Proposed Work: 11VSTAL1_ 11"AC411- ori/ <br />N �GAl //V 7"/2u�� I-iQ & <br />/NOTE -- T/�C I S 7 /3E 7 25-'gTE/_ 7 T,e <br />7557 -/- it/e 1& WovgL AW ro IWP;,o Z>1664 ,5i5- sMZ/ :74,0 <br />/Y / <br />Owner /Contractor: Fax: 1A e -mall <br />(This office toill correspond with only one designee) <br />and /or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />