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Application <br />- FOR - <br />Cervi f icate of Appropriateness <br />.Historic Preservation Commission of South Bend & St Joseph County <br />125 & Lafayette Blvd., South Bend; Indiana 46601 <br />Mailing Ammew County -City Budding, South Bend, Indiana 46601 <br />Phony 574 -235 -TM • Parc 5742351678 • Email: owju w i mst josephinus. <br />Webdta http://wwwatjaosephcountyindiana com/*hp/k&xhtml <br />OMCE USE ONLY»»» DO NOT COMPLEIB ANYENTRIES CONRM i'N THIS BOX »»» OFFICE USE ONLY' <br />Date Received Application Numbero�0 a.� . O %D <br />O - . <br />Pest Reviews: ❑YES(v&0'f1u1xwM) El -NO <br />Staff Approval authorized by: 71tle: <br />Historic Commission Review Date: <br />❑ Local Landmark ❑ Local Historic District (w=4 <br />❑ National Landmark ' ❑ National Register District pvswu) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Ubled ❑ Sent lb Committee ❑ Approved and Issued. <br />DATE ' <br />Address of Property for proposed work: <br />Stmt Nwmbar and Stmt Mm <br />Naive of Property Ownwr ): (Fk ue hw) -X11 4• Aidjar iU2 P-1— .. (T�-i°f°/ Av "m h - <br />Address:of Property Owner(s): .9' 99.x- og e o4- ?.s r. 4b I#- t>a - . Polk- <br />Contrador(s) Name: <br />Contract Company Name: A: tWpG'YLS Y— <br />Contractor Address: /C1 t L { '.44 < eo /-r- <br />. <br />City: Phone: <br />Current Use of Building: A -ex f ca. W -1 - <br />Type of Building Construction: e s +p-, <br />(WbodFrom - Brick -S-Stet-Conaria-other) <br />Proposed Work:' /In -kind ❑ Landscape E] Now g Replacement (not 1x4w) ❑ Demolition <br />(mi throwaverbatoy bedw&4 <br />Description of Proposed Work: <br />&C+, T'rF /y� .� q 1 eve— .,-I <br />r-. P- C f •c1 2ND �'T�-L <br />R . �L � Nom. 0 K �A•ST �o Rc 'tr. ... - <br />Owner/Contractor. Fax: e-mail��'��u T b'?� DISC-y�-y'! /J* -T <br />/or <br />— APPLICATION REQUMBW- 73 ARE USMD ON REVERSE SIDE — <br />