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W <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: 574235-9798 • Fax: 574235.9578 • Email S134C PMco-st josephin.us <br />Website http://www.sgosepha nmggndiana.eom/sjdip/index html <br />OFFICE USE ONLY»»»pDO NN&COMPLETE ANYENTRIES COMM M IN THIS BOX »»» OFFICE USE ONLY <br />�d <br />Date Received L40.zOv �j' Application Number z� %dr <br />- 09 <br />Past Reviews:' [] YES (Date of last Rwlew) [].NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: ! 9 OG% ZOO 9 <br />Local Landmark [focal Historic District (Name) �Dl^;ELJATL P2� <br />[] National Landmark ' ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied [] Tabled Sent To Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work: Gokc) 9VGU—� W A I O. DR, <br />Street Numberand Sheet N me <br />% <br />Name of Property Owner(s): e Print) � �� C�` <br />ZiS W IL sM <br />Address of PropertyOwner(s): (,P t QGP-, ArT'EZ DR <br />Contractor(s) Name: MIKE k,> ODES <br />Contract Company Name: <br />Contractor Address: <br />City: Phone: J • Z �j .3 <br />Current Use ofBuilding...-S,1 1!:�l I:, FAM 1 <br />(Single Family— Multi Family— Commercial— Government — Industrid — Vacant — eta)" <br />Type of Building Construction: <br />(Wood Frame — Brick — Stone— Steel — Concrete— Other) <br />Proposed Work:' [] In-kind ❑ Landscape ❑ New (Replacement (not in-kind) [] Demolition <br />(more than one box tray be d W p <br />Description of Proposed Work: o6IOvC C)l) 5-M� �A4 tlt ]i �aV � W � 1 Ci4 mz;; <br />. Nl JV TU JJ O - /\ W M 1 i4 U M I W000- ?)�:,P LAQN W 111-4 <br />r� t Q,)I P -AA Ittl t m 1) Av4(i (-u4ZSQ4 S`t.-\/elz 13R.0 U -M zu� • i rj 60 L <br />Owner/Contractor: Fax:D D 8"/ e-mail <br />(This o& will wnespond with ordyonedesignee) <br />and/or <br />— APPLICATION REOEURFMENT'S ARE LISTED ON REVERSE SIDE <br />