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Application <br />- TOR - <br />Certi f icate of Appropriateness <br />Historic Preservation Commission of South Bend a St. Joseph County. <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574235 -97'98 • Fax: 574235 -9578 • Email: SBSJCHPC®co.st josephin.us <br />Website http: / /www.sgowphcoun"ic iamcx)m /ochp /inclex.html <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received c , q ' 1D 1 d Application Number <br />Past Reviews: E] YES (Date of Lot 2 <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: `� a4i&.4 °ao/0 <br />Localtandmark Local Historic District (Name) ('h��► Yl 'PQ `i <br />National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />0 Denied [:] Tabled • Sent To Committee E] Approved and Issued <br />Address of Property for proposed work: <br />Street Number and Street Name <br />Name of Property Owner(s): (PleaseNnt) l (4 M, D ,4t Z C /S <br />Address of Property Owner(s): <br />Contractor(s) Name: • 04" <br />Contract Company Name: ' <br />Contractor Address: <br />DATE <br />i <br />YP&ryu a8e-4077 <br />City:_ .`��� ee�l� ���J� // Phone: 5 7 <br />Current Use of Building: e a/ • <br />(Single Fam — Multi- FamilyF Commerd - a ll — Government —Industrial —Vacant —etc.) <br />Type of Building Construction: <br />(Wood Frame — Brick— Stone— Steel— Concrete— Other) <br />Proposed Work: ❑ In -kind ❑ Landscape ❑ New ® Replacement (not in4ind) ❑ Demolition <br />(more than one box emy be checked) <br />Description of Proposed Work —/? Gz' CC Q /��r = -'�'� eel <br />Owner /Contractor. Fax: e-mail S/ <br />— (Thisofq" . res d only 'gnee) _ <br />and /or <br />— APPLICATION REQiIIREMENTS ARE LISTED ON REVERSE SIDE — <br />