Laserfiche WebLink
10 <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-M8 • Fax: 574235-9578 • Emaii: SB5JCHPC®co.st josephinus <br />Website httpr//www.sqosephcoungindiana.com/sjchp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 3f AW 44V 9' Application Number U D - d 8 3 l A <br />Past Reviews: EB`ks (Date ofustReview) iX.44r: 2-'Ov i E] NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 2! . -tat a"U o q <br />Local Landmark M- vocal Historic District (Name) �sract. <br />National Landmark n National Register District (Name) U <br />Certificate of Appropriateness: <br />n Denied n Tabled F1 Sent To Committee [] Approved and Issued <br />DATIi <br />Address of Property for proposed work %�f 'S�- ,L"0& <br />Street NuAber and Street Name <br />Name of Property Owner(s): (please Print) fL�e %f • r� "r't G*.�"�'�'� �t"��'d �� <br />Address of Property Owner(s): /S'/.��`► ��` l i*/P a�'�'. <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City: Phone: <br />Current Use of Building: <br />(Single Family — Multi -Family — Commercial — Government — Industrial —Vacant — etc.) <br />Type of Building Construction: <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: C] In-kind (I Landscape [I Neweplacement (not in-kind) [] Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: <br />7— <br />Owner/Contractor. <br />Owner/Contractor. Fax: / e-mail <br />(This ofceun th on design <br />ar d/or - <br />— APPLICATION RE - UIRE TENTS ARE LISTED ON ,REVERSE SIDE — <br />