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Application <br />FOR <br />Cern fieate of Approprianess <br />Historic Preservation Commission of South Bend & St_ Joseph County <br />125 S. Lafayette Blvd., South Bend, indiana 4,6601 <br />Nailing Address: County City Building, Snuth Band, lndiaruz �iC;i <br />Phone: 574-2359-798 • Pax: 574-235-9578 • Email: SB5)CHPC@)co.st-josgb-irLus <br />Website: littp://wws, stjnsephcountyindiaiia.coni/s(l►p/index.lttml <br />01-TICE USE ONLY»>y» DO NOT COiVIPLETE Ai\'Y EArIRIES COiUVIN'ED IRr THIS BOX »>"> OFT1C1' t(SE O,\II.Y <br />Date Received /3 ©c -r• -200? Application Number /0/3 <br />Past Reviews: LV -VES (Mkeof L461 Rev;ew) 54PR• 200 Z._.__ .. [ NO <br />Staff Approval authorized by: 'Title: <br />Historic Commission Review Date: iG /la tr <br />[� Local Landmark [j 'Local Historic District {;varve} � W4 pwes <br />[] National Landmark n National Register District (Name) <br />-Certificate of Appropriateness: <br />[� Denied 0 Tabled F� Sent To Committee ❑ Approved and Issued <br />i)A1E � <br />Address of Property for proposed work: E u'r`ic �` r -e i ` rim '. <br />Street Number and Street Name <br />Name of Property Owner(s): (Plme Pant) 1 �� � f' -s `) tt , -_U c i�__...__........_"_.-_..........._..._ __—._._.._......._ _....._................. <br />Address of Property Owner(s). {�S, A IVA 1- 1 '� tO 1" 5 i <br />Contractor(s) Name: QTR. i �1> �" 1 L"c I:. S "oe C0 p -s - <br />Contract Company Name: r:s►1 k., e .. S i,9 Z? co /-Is 1 A i VC, Tt 0 <br />Contractor Address- ,oQ L <br />city: 'I l X14 '4tv/ - tM Phone: l" 7 4- 5 <br />Current Use of Building:f <br />(Single, family - Minti-f amilu - com"tercial - Government - lydustrial - Va nant - etc) <br />Type of Building Constniction: 4i/Cn' !'f, 4A1 t~/ '? j ' r' <br />(VIVow,I frame - Brick - Sterne - Stec! - Conrretc- other) <br />Proposed Work: Klin -kind [:] Landscape [jNew ❑ Replacement (not in-kind) E] Demolition <br />, <br />(in= il:an one baa nvy be cheded) <br />Description of Proposed Work: R tA r"' L --'t., c= � � i a' � 6 �' ' ° � � Z_ y � �� A L' c`/A'i }e- <br />f4' 3 ` AA, v,' <br />� � � l i.. t\.�1. {�: `S !�'.L/ s.:. A L�+ /� J .rt...i'Y`� �,. � `,+..✓ - <br />Owner/Contractor: Fax: ��`� 1 �f e-mail <br />(This o!j;, w i rit rise with only erre designee) <br />a <br />and/or - _--........ ..... ...._ <br />—._.. _...... , _.._......_.._... __.... _ ...._._._.__._.._.._. <br />-- Ar-1111CAT70NREQ t1iRl: WENTS ARE LISTED ON REVERSE SIDE �--- <br />