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ak or i <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: 574-235-9798 • Fax: 574235-9578 •. Emait SBSJCB PC@m st josephinus <br />Website http://www.sgosephcounVffidian&com/sjchp/index.hbnl <br />OFFICE USE O > > >- D T OMPLEM ANY ENTRIES CONTAINED THIS BOX f>>>>>> �CE USE ONLY <br />Date Received Application Number v�� <br />Past Reviews: ❑ YES (Date of Last Reotem) F] NO <br />Staff Approval authorized by: Title: . <br />Historic Commission Review Date: 01 <br />Local Landmark ❑v' Local Historic District (Name) <br />VeeiV� <br />F1 National Landmark F1 National Register District (Name) <br />Certificate of Appropriateness: <br />Ej Denied [] Tabled [] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: 1047 - 1 VEPS!r) F_ <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) _ 5�vs_ <br />Address of Property Owner(s): ,/� ��V L YLNo <br />Contractor(s) Name: 14 L -D • if MA-P*A <br />Contract Company Name: + K ifaU 4-70 /Z S <br />Contractor Address:1' %1l_ fi LL �(,L /p <br />City: JnlTll 131 hl� / I_ Phone• F'7�'/-' <br />Current Use of Building- <br />(Single Family — ulti-Family — Commercial — Government — Industrial — Vacant— etc.) <br />Type of Building Construction: 410 o - <br />(Wood Frame — Brick- — Stone - Steel — Concrete —Other) <br />Proposed Work: In-kind ❑ Landscape ❑ New E] Replacement (not in-kind) ❑ Demolition <br />(more than one box may be cheeked) �/- j <br />Description of Proposed Work:. �1 !,t,, o +'IZ -rile 91Z) <br />fi=/Z%�/'tlltf. <br />/-?f-!%z P(,Lli3' USth/� <br />jl f'L S —W Loi <br />wner/ actor. Fax: <br />(This e f m rrespond with only onj designee) <br />s <br />and/or <br />e-mail <br />— APPLTCATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />-77-If <br />