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Application <br />-FOR - <br />Certi f icate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing AAA Building, South Bend, Indiana 46601 <br />Phone: 574 -235 -9798 • Fax: 574 -235 -9578 • Email: SBSjCHPC@co.st-joseph in.us <br />Website: http:// wwwsgosephcountyindiana .com /sjchp /index.hhnl <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CONVIINED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received / 0 -1W1 61-610 Application Number Z Q l - U �b1 <br />Past Reviews ❑ YES (Date of fast Review) <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />i <br />❑ Local Landmark ❑ Local Historic District (Name) P <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: J ILL U Q �G- P D ' �0 <br />U" <br />StreetiNumber and Street Name <br />Name of Property Owner(s): (Please Print) �Qa LA-C 1 %;; u.V <br />Address of Property Owner(s): �Q� t4. &- v D <br />Contractor(s) Name: Ste' i F <br />Contract Company Name: <br />Contractor Address: // <br />City R Phone: k5l k ) D I e Z I <br />Current Use of Building S I 1 'L ` <br />(Single Family —Multi - Family — Commercial —Industrial — Vacant —etc.) <br />Type of Building Construction: k_x y ( V <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />O <br />Title: <br />1 <br />Proposed Work: ❑ In -kind 02 andscape ❑ New ❑ Replacement (not in -kind) ❑ Demolition <br />(more thmi one box may be checked) <br />Description of Proposed Work: "� ►"1_� 1 �] [ Z�� 6J l J� 1� <br />hp l ,� -h--�P R- e�no�v�. .E,s c ivy f1 E- t >I n rat DI -I wt 4- <br />I UI& MYtt(Ii t I % . <br />e -mail-0 w''] i C' 0- 94-10_� C <br />0 <br />and /or <br />— APPLICA77ON REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />