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Application <br />— FOR <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />12-7, S. Lafayette Blvd., South Bend, Indiana 46601 <br />Skilith Bend Indian- 460,01 <br />Pho-ne- 5774 -2'15-T798) Fax: 5774-r35-9578 - E nui il: SRSJCH P0@?;co.5 t-joweph. in. u s - <br />Website: littp://WWIV,Stik)SL'I)Iicouiity.iiidiiina.coiii/,sjclip/itiLlex,.htnil - <br />OFFICEIISE O;VLY>>>>>> DO NOT COMPLETE ANYENTRiES Cil i4 IN THIS ITOX >>>>>>'OIT1CI-. (ISE ONLY <br />Date Received -i...v" .40 Application Number <br />Past Review -s: F-1 YES (rhaeoflam Review) NO <br />Staff Approval authorized lky: Title: <br />Historic Commission Review Date:/5 4 � 2 ev q <br />17 Local Landmark <br />E] Local Historic District (fume) <br />National Landmark E] National Register District <br />Certificate of Appropriateness: <br />Denied Tabled ] Sent To Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner(s): R,01 11VCv,- ANkevwx <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: (A <br />City: <br />Phone: <br />Current Use of Building- �L tiL f 40 L, 1, 1, 1-, <br />silrglr [Wiffill -- Muhi-Family - CemnTrrrial Owerrimwnt - Indwfri.rd Vurant- etc,) <br />Type of Building Construction: VVq-d "FW <br />(I-Vbod T.ramre - Brick - Slane - $teel -- Concrae - OV'ier) <br />Proposed Work, ln=kind -,e Landscape [] New Replacement Dernolition <br />(Inoir th"a onc IVI, nmv be chechil) <br />Description of Proposed Work: --y4t C -e <br />—m t a P4. <br />Owner/Contractor: Fax: <br />(77"'s 0,jicr will cern l-vild with im'I'V f,'?W drsipur) <br />and/or <br />APPLICATION R.EQl,HRE,'V1E,%17S ARE LIS7TD ON R1.71"ERSE SIDE <br />