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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: SBSJCHPCgostjoseph.in us <br />Website: http.Ilwwstjosephcountyindlana.com/sjchp/ <br />A Certified Local Government <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received -706,9 Application Number 9 - 0 9 eZ 414 <br />Past Reviews: v 'ES (Date of Inst Review) i g 3 E] NO <br />Staff Approval authorized by: <br />Historic Commission Review Date: 021 X� 40V 9 <br />n Local Landmark ErLoeal Historic District (Name) G <br />[] National Landmark F] National Register District (Name) <br />Title: <br />Certificate of Appropriateness: <br />E] Denied E] Tabled E] Sent To Committee F� Approved and Issued <br />DATE <br />Address of Property for proposed work: 1307 b✓A-L/A/C-_- 2Z z"T Ncr;2T7� <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) _ -7- ic•Ic r( - <br />Address of Property Owner(s): SA -me <br />Contractor(s) Name: F3aoc_t^ (ti/tLSV1,_) <br />Contract Company Name: 1b60. wLA77W- *BX161C PiTVC-i *- Gc� •vc_rtf 71= % � <br />Contractor Address: ;_:7(;r'5 bc—ol i a- ice'..; <br />City: Ai ,C-C.S y Phone: -51 7 c/" Z5 j -600 6 <br />Current Use of Building: _ -- <br />Sin Ie tir1'l Multi -Family — Commercial — Government —Industrial —Vacant —etc.) <br />Type of Building Construction: <br />(Wood Frame - Brick � Stone - Steel - Concrete - Other) <br />Proposed Work: 2 In-kind Ej Landscape F] New f� Replacement (not in-kind)El <br />Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: �i✓ P( �C � D ix i t tnl� rtf Sac. r D Go ntC 2.ErE 1 <br />IN-- KINcy i-(['-tti1�At- CCS All C,1 i c) F- Irv•AL1C_t)Vo1-1 r f"-, c)t.,-1 7 <br />'>o i .t -Y1 , 7� ,Ti (-1z' V.rOA-k_ C;N <br />Owner/Contractor: Fax: ui�,..�c/� ����tU•`l e-mail <br />(This office will corrapond with only one designee) <br />and/or <br />Signature of Owner Signature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />