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Application__ <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S Lafayette Blvd., South Bend; Indiana 4.6601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574235-9798 • Fax: 574235-9578 Email: SMJCFff.C&o.st jsephlaus <br />Website: hd ://www.sgosephmurt44ndiamcom/s,;chp/index.html <br />OFFICE USE ONLY>»»> DO NOT COMPLETE ANY ENTRIES CONADVED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received O79ew 0? "9'0 q Application Numbera UD _ DSO <br />PastReviews: 2,MS (DafeoflastReview)--'"�T`s"'r , 07471 0•N0 <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: h r_'P?00 5 -- <br />FlLocal Landmark B Focal Historic District (Name) <br />National Landmark E] National Register District (Name) <br />Certificate of Appropriateness: <br />Denied ❑ Tabled '0 Sent To Committee [-] Approved and Issued <br />DATE <br />Address of Property for proposed work: F�)GP 1 Eg <br />street Num <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner( s): Q0 E G t,: W ATER [R- W <br />Contractor(s) Name: <br />Contract Company Name: Kl r4 (-vWM NK..k)�,RS - <br />Contractor Address: iso �Ji� - r 3 <br />City: �i pc�P�N l t Phone: 2.15. 9 2 69 <br />Current Use of Building: SIV.GU. N:A MIINI <br />(Single Family—Mull-Family— Commercial —Government — Industrial — Vacant — etc) <br />Type of Building Construction: <br />(Wood Frame — $rick — Stone— S3el —Concrete — Other) <br />Proposed Work:' In-kind [] Landscape n New XReplacement (not in-kind) 0 Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: kJE:PL , C hI N 1--) WV FT:WU- W _ ktJ 1i 1Tt V 1 tVV L- <br />. t <br />Owner/Contractor. Fax: e-mail 5E C -j FS A0L-6PK <br />(This of=wdl correspond with only one designee) 1 t <br />and/or.- - - <br />— APPUCA77ON REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />