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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-Ci#y Building, South Bend, Indiana 46b01 <br />Phone. 574-235-9798 • Fax: 574-235-9578 = Email: SBSjCHPCCko.st josephinus <br />Website: http://www.sgosephcountyindiaro-com/Ichp/indmhtml <br />OFFICE USE ONLY »»,/»A DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 4 A44 � ooq Application Number e d !� ? <br />Past Reviews: ❑ YES (Darr of Inst Review) <br />Staff Approval authorized by: <br />■ • <br />Title: <br />Historic Commission Review Date: 02l Z&. omo 9 <br />Local Landmark 12"focal Historic District (Name) <br />[� National Landmark n National Register District (Name) <br />Certificate of Appropriateness: <br />Denied [D Tabled n Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work / o/ 6 <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print)3rr,� i c;�ea4-7Z <br />Address of Property O r(s):cTiGELc7- <br />Contractor(s) Name: 1 iY ,Cr Q* -W >- - T eotr <br />Contract Company Name: A"V ETC! a'iW 'clan r',i <br />Contractor Address: Vi> e Roc, - 772- -- C/C Z -Po <br />City: Phone: 45-7 y-- 2 7 C. -'}LG / et.&ALr­- <br />Current Use of Building: - <br />y(�Siingle Family -Multi-Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: K&4WC <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: In-kind Landscape n New placement (not in-kind) n Demolition <br />(more than one box may be checked) _ <br />Description of Proposed Work:% 7.sF l�X-�t7 L.e� t�/Tl/ ACc Z3 <br />Owner/Contractor. Fare: ,5_7�4-Z8 �_ 7� �3 e-mail <br />(This office=71 correspond with only one designee) <br />� (y p <br />1 r�++ ,3 a�,�i - and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />