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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Conunission of South Bend & St. Joseph County <br />125 S. iafavcqte Blvd., South Bend, Indiana 4t(1)01 <br />A1aiHng Address: County City Building, South Bend, Indiana 4i,t,tli <br />Phone: 574 -?'i5 -9M • Fax: 574-115-cf57ii • Email: SBSJC:HPC@,co.st-joseph.ita its <br />Wetx>ita: htip'//wwtv.stjost!phcountyindiana.corn/.*hp/ uidex.htnll <br />OFFICE USE ONLY»»» DO NOT COMPLETE ANY ENTRIES CO,NI4INED IN 7711S BOX »»» OFFICE USE 0,N Y <br />Date Received 16" OC -7' 2-01>9 Application Number__. • !1' /S <br />Past Reviews: Ct.t"�ES {t�t,f at is:: u�-r:��>_. 40 MAY -406 g [ } NO <br />Staff Approval authorized by. <br />Title: <br />Historic Coinruissfon Review Date: ll --"4 " '°FOO <br />Local Landmark ['Local Historic District (,%amr) <br />Li National Landmark J National Register District CVartr) <br />Certificate of Appropriateness: <br />[-j Denied [] Tabled E] Sent To Committee [1 Approved and Issued <br />VAtF <br />Address of Property for proposed work; est LAC <br />Street Number and Street ddvntr <br />Name of Property Owner(s): (Pimse Print)- rt �_ L n - i in d e 1 C <br />Address of PropertyOwner(s): ""_ ' t �°'' �"' "rr r'`'`n tie✓:� Its ttF'dlf; <br />t f -t IYSt, �itr'Y �'"t tliDi+✓.twYi �'-)'t ✓f Fo rJL rstr <br />Contractor(s)ltiartle: <br />Contract Company Name: JW <br />Contractor Address: � 3 1'16 -b7 <br />City: ttr,SC ft ft'w, MC Phone: <br />Current Use of Building: fin�lt �arn�ly <br />;Sirgir F:t�ntiy - ;Sttu)tr f;;!n,t3; .Cunt+ru'r..a: - (;^�errrtzvtt-1.^.s:t«>tr,�i -Natant -etc } <br />`type of Building Construction: <br />(N9a7d Fr;tmr - f3ria - Stan. - Steel -Concrete - Ofhr) <br />Proposed V%fork: ? [] In-kind ElLandscape n New '❑ Replacement (not tn•kimf) i Demolition <br />(rnmc tt»tn one ba o4y be citt"ed) <br />Description of Proposed Work: tet-i-er <br />Owne rlContractor. Fax: c#-rnaii <br />rrn»t»tyrrr.OnNone dtaijner.) <br />ilt�bl....'..... .............. _. .._..asci/cr._......._�..._..__..___-.._.._._..._ _.._..,......... <br />A.PP1JCAI16Nt RL QUIRIDNIEN'IS ARI: LIS7`I:D ON REVERSE' SIDE -- <br />