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,. Sep. 2. 2009 9:20AM I&M Buchanan No. 8711 P. 1 Application - FOR - CeM f icate of Appropriateness Historic Preservation Commission of South Bend & St Joseph County 125 S. Lafayette Blvd., South Bend, lndiam 46601 Mailing Address: County -City Bw".din_ g, South Bcnd, Indiana AWM Phone: 574 -Z5 -YM Fax: 574-23,5-%75 i Email: SB5jC PC®cost josephin us Website: htgr//wwwsgosephcountymdiatna com/rAT/index html OFFICE USE ONLY?y5-aa5, DO NOT COMPLEM ANYENTRIES CON EVER MMS BOX »»» OFFICE USE ONLY Date Received •S let t ,ZOO, Application Number � 00 q _ /00 S(?,, Past Reviews: ❑ YES (n k o al roidw) ❑ NO Staff Approval authorized by: c Title: - Historic Commission Review Date: 00 ❑ Local Landmark (Local Historic District (Name) ❑ National Landmark ❑ National Register District (Nam) Certificate of Appropriateness. ❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued DATE Address of Property for proposed work: ace -44 Ave, a L njrh gg muel; Soret Number and Strat Name Name of Property Owner(s): (Pieria Print) iCL�\ Y_ r Address of Property Owner(s): $102,— n res -� A V t / M ANf TD ti t Contractor(s) Name: X Contract Company Name: Contractor Address: 40 AzA Iu �r�i '� (Nt--sk City: - r Phone: „ - T1:2<R4 Current Use of Buildinp- 24ci - US - 5- S M (Single Family—Multi-Fanigy—Commercial—Gacerm=f —Industria! -Vacant —etc.) Type of Building Construction: (WocdFrame — Brick —Storm—Red — Concrete —Other) Proposed Work: ❑ In-kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition (mon than one box may be ched4 Description of Proposed Work: Re- es tt V P, ro %41 �+n � n� l`'!Li'�i11 bra r � �r r � ; rw�5 Owner/Contractor. Fax: slab - WA - 'I ,� e-mail (no of=WM cvrne M d with only one designs) and/or — APPLICATION REQIIIRBENTS ARE LISTED ON REVERSE SIDE — u