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Application <br />FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 & Lafayette Blvd, South Bend, Indiana 46601 <br />Mailing Adr1mg.- rrmt"fiy-rvky Building, c-..ju Bend, T -A— 46601 <br />Phone: 574235-9798 0 F= 574-235-9578 * Email SBSjCHPC0mst-josephirLus <br />Website hV//wwwstp-%phantn"diaMCDM/fgchp/mdexhtmI <br />OFFICE USE ONLY >>>>>> DO NOT COAPLEU ANY MMMS CONAMID IN THIS BOX >>>>>> OFFICE USE ONLY <br />Date Received t kAv--21- Application Number MO Z <br />Past Reviews: [BA19S (Date of Lot Rmk.)jg!"&t E] NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date. <br />E] Local Landmark D�ocal Historic District (Name) <br />n National Landmark F1 National Register District ovame) <br />Certificate of Appropriateness: <br />F1 Denied E] 11abled [:] Sent To Committee F, Approved and Issued <br />DATE <br />Address of Property for proposed work: ell SO 7 o ` <r-, -L,, ,,-77/ <br />'Street Number�andStreet m'e <br />Name of Property Owner(s): (PIMe Print) <br />Address of Property Owner(s): <br />Contractor(s) Name: Ck"-'e4C hlitgolO <br />Contract company Name: D6004AWPEF 13,�(L G« ClZr- a C <br />j; Af <br />Contractor Address: I,- f_+ mc)a_- Y'? <br />City: Pit C� Phone: '51Y01-100 <br />Current Use of Building,- Y <br />(Single Family - Multi-Fandly- Commerdal - Government - Industrial - Vacant - etc-) <br />Type of Building Construction: i3Ay6K. <br />(Wood Frame - Erick - Stane - Steel - cancrde - Other) <br />Proposed Work: E] In-kind E4=dscape ERNew Replacement (not inhnd) E] Demolition <br />(more than one box my be d=td) <br />Description of Proposed Work:/ l -7r, -,/,IL V'rl Ael-;,.>I- s <br />Owner/Contractor Fax. 415, e-mail <br />(M offlM wX carraqvW with only one designee) <br />and/or <br />APPLICATION REQUIRUMM ARE LISTED ON REVERSE SIDE — <br />