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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. tafayette Blvd., ".youth $encs; Indiana 46601 <br />- Mailing Adder -City Building, South Bend, Indiana 46601 - <br />Phorm 574-2.35-9 A,8 • Fax 5774 -X5 -m • Email: bIbA HIr .werco.st-joseghfnus <br />Wei>sitei hfp//www.s"hmuntyincbwa cum/op/hulv.l d <br />OFFICE USE ONLY --»x,> DO NOT COWLM ANY ENTRIES CONZiINI±A IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 1, X6,94 0 Application Number d` LSI c i f <br />Past Reviews: E] YRS (restsof tat&vkm) [].NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />n Local Landmark cal Historic District QVXMa) . f� <br />[] National Landmark E] National Register District ¢vainel <br />Certificate of Appropriateness: <br />Denied (] Tabled '[j Sent To Committee ' [ Approved and issued <br />DM <br />Address of Property for proposed work: 2c) 9 E W (xury_ <br />shift-lyrntba and street Name <br />Name of Property Owner(s): (Pkvn Print) '1 ' ' o cy--� <br />Address.ofProPAY �)Owne: ' <br />Contractor(s) Name:La� �'�r.�-; t�s`Yi�''�S?rit'�x-► l,.t.,C': <br />Contract Company Name:C=fir;' <br />Contractor Addmms t1(-,11 `" - 6kc NN 'NvA-- , VA'C' <br />City: e: <br />Current Use of Building: -. <br />(Single Fanniy Multi-FaMdly - ComrnMW - Gova xMt - Industrid - Want- dM) <br />Type of Building Construction: <br />(Wood Fraw - Brick - Storer - Sted-Canade- Other) <br />Proposed Work? Q In-kind ❑ Landscape ❑ New ARepiacement (not hvmO❑ Demolition <br />(maretrym b=mybet <br />Description of P'mposed Work: 4 >, ;� " (7 t ► }r ±._,to :�i �1�1n t l n - t <br />—U:. <br />0 Owl <br />Owner/Contractor. a:c � r 1 � e- Ut r <br />F mail <br />(M anTt arr°rtpond with anlyoxc dr8lgnes•) _ <br />,1 and/or - <br />-- APPLICATION REQUIRBENTSS ARE USIED ON REM SE SIDLE — <br />