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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: SBSJCHPC@co st joseph.in.us <br />Website: http://www.st osephcounVindiana.com/s chp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONRR%1ED IN THIS BOX-- OFFICE USE ONLY <br />Date Received 45'067.ZM9 Application Number oZOO _ /DOS 1i <br />Past Reviews: 9YES (Date oflastReview) -44144V. -ZO07 E] NO . <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: /y OGT .2100 9 <br />n Local Landmark ER focal Historic District (Name) <br />E] National Landmark n National Register District (Name) <br />Cerfificate of Appropriateness: <br />❑ Denied ❑ Tabled . 0 Sent To Committee 0 Approved and Issued <br />DATE <br />Address of Property for proposed work: 1:771? r--AS'E' MAyY1 B -574- Net-" ' - <br />Street Number and Street.Name <br />Name of Property Owner(s): (Please Print) G K AV -1 eS LA VIA J /%OI V1 L C n r1 O n <br />Address of Property Owner(s):. 1-2213Z EA1G+ W/ yvi E Sri. R bv-4� <br />Contractor(s) Name: �70p�lY1- 1" YeM 0O1'*-+r14C+iv(n . I hr, <br />Contract Company Name: ll <br />Contractor Address: t' 2 94-0 �v-ot n r,1 S ST ree <br />City: 5A4+h Send Phone: 74%17-2-5;07g <br />Current Use of Building: S•l h DI' ' f='A l I / <br />(Single family - Multi -Family - C mercial - Government - Industrial - [scant -etc.) <br />Type of Building Construction: Woad <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: E] In-kind E] Landscape X New E] Replacement (not in-kind) ElDemolition <br />(more than one box may be checked) <br />Description of Proposed Work: l AeAet- $;,P'Ardon-1 scean,� "'t ,Pr GA A 1+t 27rN . <br />abDr�x. 2a'x (Ca , an -t-h sr As+ corner /,,4-' he, �. <br />r� <br />Owner/Contractor: Fax: G,74. IT99. 2S . &&V - e-mail- ktflead <br />(This office will correspond with only one designee) <br />W I I 11A r� P,. LA' M I C R, 164 IN and/or <br />owner 1Ze ?rPsen4zt4 ive. <br />— APPLTCA71ON REQUUZEMENTS ARE LISTED ON RETERSE SIDE — <br />