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Application <br />- FOR - <br />Cercif icate 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=235-4798 • Fax: 574-235.957$ • Email: SB5jCHPC@?co.st josephinus <br />Website: http: J f www. stjosephcoun"Khana.com/op f mdex.html <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONTAINED INTHIS BOX »»» OFFICE USE ONLY <br />Date Received Application Number a � q - m,4 7 <br />Past Reviews: El YES (Date of Lotlteview) <br />Staff Approval authorized by. <br />Historic Commission Review Date: <br />Local Landmark Local Historic District (Name) <br />National Landmark [] National Register District Name) <br />Certificate of Appropriateness: <br />M • <br />Title: . <br />n Denied ❑ Tabled ❑ Sent To Committee 0 Approved and Issued <br />DATE - <br />Address of Property for proposed work -3 4 � F6"51- .Am «� t � � I!'�/ r�0 <br />Street Numberand Street Name <br />Name of Property Owner(s): (Please Print) r �t,t�lftl< Y t .11t <br />Address of Property Owner(s): _A0 6w <br />Contractor(s) Name: �Ct��v -�1 a N w L14d ow ,i <br />Contract Company Name: <br />Contractor Address: 71 S* W, � j t,50rt Qdtt j <br />1 ' <br />City: ,/ Wt.tSht��f 14 40 (4 J- + Phone: <br />Current Use of Building: A0 4 i ' 4z $4t, 1y <br />(Single Family— Ainti-Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: Fzov ' sitxq " 5 �►k k <br />s (Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: E]In-kindE] Landscape [] New Replacement (not in-kind) ❑ Demolition <br />(more than one box may be choked) Description <br />Description of Proposed Work:,._ ��Vtl W t+146(a G 1,A 66ljy <br />Owner/Con or: Fax: e-mail <br />(This vrtIco uRthonlynrtedesignee) — <br />w <br />............. <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE -- <br />