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Application <br />FOR - <br />Certificate of Appropriateness <br />Historic Preservation Cornmission of South Bend & St. Joseph County <br />S. Lafayette Blvd., South Bend, Indiana 466GI <br />Mailing Address: County—C; B-1dit SmithR—iAI Indiana �Arrll <br />I 'CP <br />Plione:5774-235-9798 - Fax: 57-4-235-9578 9 Eiiiail:SB.SJC-liPCit.-co.st-joseph.in.us <br />W'ebsite. http://vvv4-tt�.stjosephcountyindiana.coin/sichp/inde,<.Iii7iit <br />OFFICE USE ONLY >>>>>> DO NOT COMPLEFE ANY EYFRIES COMMINED IN THIS BOX OFFICE USE ONLY <br />Date Received L Application Number4_4 <br />Past Reviews: 1:1 YES (Vara, qLlst Revim) <br />Staff Approval authorized by: <br />MM <br />Title: <br />Historic Commission Review Date: <br />El Ipc-,71 Landmark di,ocal Historic District (,Vame) <br />National Landmark 0 National Register District (Mante), <br />Certificate of Appropriateness: <br />Denied f_Tabled M Sent To Committee M Approved and Issued <br />DATE <br />Address of Property for proposed work: !317- Wa,, ate �4. a <br />stred Nuber <br />may'd StnxNa <br />t we <br />Name ofPropertyOwner(s): (Ploise llrifa) bav i4 � 0"j '4 rpt. 44t - <br />Address of Property Owiier(s): l3 W6ofAt- <br />Contractor(s) Name: Mol i'"'- <br />Contract Company Name: Rou�.ni C.'a 614c --ham <br />Contractor Address: A[, <br />city: Sn-� Ber4 Phone: <br />Current Use of Building: Srh/e <br />(Single Famil ' V - Mul"i-Familly - Om <br />)txrcial - GozvrnmeW, Mdu5!rW Vua <br />ant de') <br />Type of Building Construction: U004 Frr.', S�Vne, <br />(I'VmdFramv - Brick- StLwe - Sted-C6rcrete --Other) <br />Proposed Work: F-1 In-kind [] Landscape V] New F-1 Replacement (nvt in-kind) Demolition <br />(mare than ore box lfvrj ly aheckal) <br />lVaa Description of Proposed Work: <br />AWI or7AAA <br />PUA-S Ck to-tra. � 40r+ 2_0' <br />40, e <br />VQL CL <br />G:K+ c MW <br />(_(5Goner _;r_oti4actor: Fax: e-niail <br />and/or <br />APPLICA77ON REQUIREMENTS ARE LISTED ON, REVERSE SIDE <br />