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Pd= C4��1535 <br />SpUTBB� Application 1y `oNµisetoNFq�o. <br />FOR -r •.. <br />Certificate of Appropriateness b <br />Historic Preservation Commission of South Bend & St. Joseph County .; <br />r 125 S. Lafayette Blvd., South Bend, Indiana 46601� ti� V. <br />i86S ding Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 a Fax: 574-235-9578 • Email: SB5JCHPC@co.stjosephin.us <br />Website: http://www.sqosephcounqindiana.com/sjchp/indexhtnd <br />OFFICE USE ONLY > >> T COMPLETE ANY ENTRIES CO THIS OX »»» OFFICE USE ONLY <br />Date Received T <br />� Application Num�Q 0 - 04/10/e! <br />Past Reviews: YES (Date of Last tteotew) E] NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: V'���'j <br />Local Landmark " 2"Local Historic District (Name) vnp- <br />E] National Landmark E] National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied F] Tabled E] Sent 7b Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />Stmt N mber and Street Name <br />Name of Property Owner(s): (Please Print) %! /uT aL7�� <br />Address of Property Owner(s): �0 <br />Contractor(s) Name: �,D �lGL /1'I Y-Sov-S !','r+Y <br />Contract Company Name: r l d /Z QL% SO v11S J <br />Contractor Address: <br />City: L '/�/� �G Phone: 703 0 <br />Current Use of Building: �NGTGG /�ft�,r✓G7' <br />(Single Family - Multi -Family -Commercial -Government -Industrial -Vacant -etc.) <br />Type of Building Construction: /—^1to4 4!5 <br />( Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: In-kind [D Landscape Newf Replacement (not in-kind) E] Demolition <br />(more than one box may be ehacked) � (— A �,,� <br />Description of Proposed Work: A!5P4 4.- 64V QAW/7�CJ <br />.e / C_dmem 42/l OP lig:rg V 7 d/ <br />1 L_4 7&5 Td rn. 9J <br />Owner/Contractor. Fax: 1,4,(1" e-mail <br />Wtis c fce will correspond with only one designee) A117y_'ry jV �— <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />���7�1�e ��� t�r� �� !W s�� ,�.o�•7it� <br />