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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: SBSjC1UC@co.st-joseph.in.us <br />Website: wwwsgosephcountyindiana.com/sjchp/index.htn-d <br />A Certified Local Government <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED ix THIS BOX »»» .OFFICE USE ONLY <br />Date Received J- 04! % •?0V 9 Application Number o2 - /a o 5A <br />Past Reviews: - 2-fis (Date of cast Review) %i"L-P, <br />Oa 7 [:] NO <br />Staff Approval authorized by, Title: <br />Historic Commission Review Date: ! q (JGT• ZOO? <br />Fj Local Landmark ['Local Historic District (Name) <br />National Landmark B National Register District (Name) <br />Certificate of Appropriateness: <br />Denied E] Tabled E] Sent To Committee Approved and Issued <br />DATE ` <br />Address of Property for proposed work:DL <br />Strdet Number and Street Name <br />Name of Property Owner(s): (Please Tint) , �ell-. <br />Address of Property Owner(-,. ' v c> a l � '•"'c�,P ��'' �G6 ;_.jr <br />j <br />Contractor(s) Name: n -{- <br />3 Contract Company Name: <br />Contractor Address: <br />City; Phone: <br />= Current Use of Building: - <br />3 (Single Family ulti-Family - mmercial _ Government -industrial -Vacant -etc.) <br />Type of Building Construction: <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: In-kind Landscape E] New 2IReplacement (not in-kind) Demolition <br />(more than one box may be checked) I <br />Description of Proposed Work: 90 (ow -e nsei-r't' t ` �J '`�� G ti1l TO <br />v�tfly. <br />Owner/Contractor. Fax: e-mail <br />(This o will correspond onl -- <br />and/or <br />bignaturrof pwner Signature of Contractor <br />— ,r ARE LISTED ON REVERSE SIDE — <br />