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t <br />I <br />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 • Ema l: SBSJCHPC&o.st josephin.us <br />Website: http://www.st osephcountyin ana.com/sidT/index html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONWVED IN THIS BOX —""OFFICE USE ONLY <br />Date Received old -t"t 02 0W 9 . Application Number ,4 - 0 9 2 L <br />Past Reviews: r-1 YES (Date o/last Review) <br />Staff Approval authorized by: <br />E] NO <br />Title: <br />Historic Commission Review Date: 9 �rf 0?00 9 <br />Local Landmark ® Local Historic District (Name) <br />❑ National Landmark E] National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work: 1S RS�1(�AND R�f�. <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) _SAND -j Atti",A-iA N k, <br />Address of Property Owner(s): t3ls N.0 A LAND a,/F. SoL)n4 BtnNL 0 ,Al- yLW(a <br />Contractor(s) Name: 5C -LP <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Current Use of Bu1lding:--,&1N6L6 I:Amo LA <br />Phone: <br />(Single Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: wanD PkAmr <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: Q In-kind F-1 Landscape Q New F� Replacement (not in-kind) E] Demolition <br />(more than one box may be ducked) <br />Description of Proposed Work: T , A .Jr Tr, A ►11 Pr Pteu e- r, cltoS-c, rr A D 2, Lr w A -{ <br />w 1Tt1 R G.Arr FepM M rl N t=16nApZs tfoos rn M ►Ne? . <br />Owner/Contractor. Fax: e-mail cro i.sef — ',1'14 2.1 A '-W-C"-' <br />(This office will correspond with only one designee) <br />and/or - <br />— APPLIMHON REQWREMUM ARE LISTED ON REVERSE SIDE — <br />