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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 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: SBSJCHPCQco.st joseph.in.us <br />Website: http://www.sgosephcountyindiana.com/s chp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received /-F Oe -7 2609 Application Number t'a O R - i0 `8 <br />Past Reviews: F1 YES (Date of Last Review) E1 'NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 16 NO V 260,9 <br />E] Local Landmark Eiv Local Historic District (Name) EAV.9.0 ,g <br />F1 National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />Ej Denied F� Tabled ❑ Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: o� G(//4 C%,(�r �:� <br />Street Number and S eet Nam <br />Name of Property Owner(s): (Please Print) ��� ��,[A �✓ <br />Address of Property Owner(s): <br />Contractor(s) Name: RA.q h o eK <br />Contract Company Name:-,���q,, ��% � I DA <br />Contractor Address: / " � / y 'V ; <br />City: Mi's dJ )V+14 /I'A/A J/V Y&5 `v Phone:%? " o796?" <br />Current Use of Building: _('9-AXA-G <br />(Sing � Family — multi -Family) Commercial — Governmeht .— Industrial = Vacant - etc.) <br />Type of Building Construction: RILL <br />Proposed Work: In-kind <br />(more than one box may be checked) "`""" <br />Description of Proposed Work: <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Landscape [j New'-AReptacement (not in-kind) 0 Demolition <br />D W%A) <br />f <br />Owner/Contractor: Fax: 17Y'� �' ' 01? e-mail <br />(This office will correspond with only one designee) <br />% and/or <br />— APPLICATTON REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />