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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 />W4qll;nty At4timew Cou -Cit Build a. n—A Indiana 4f11 <br />f I <br />Phone 574-235-9798 • Fax: 57-1-235-%78 • Ema• SBSjCHPCVw.st-josephin=s <br />Websita httFr//www*sL-pha)untyindiana.com/s cbp/index.htmI <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONTAI IN THIS BOX » »» OFFICE USE ONLY <br />Date Received 16 ,/ "?evo Application Number _��) / Co . e / C- <br />Past Reviews: � YES (rjwef toss RrvL0 <br />Staff Approval authorized by: <br />Historic Commission Review E <br />Local Landmark <br />National Landmark <br />Certificate of Appropriateness-. <br />Denied [] Tabled <br />7110 <br />Title: <br />late: alo ' L*6"ttf) "U "'o <br />21,cical Historic District QV..,) / <br />[g Register District (Name) <br />E] Sent To Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work: _5 7 i _�-�J'' e-, <br />Street umber and Street Nome <br />Name of Property Owner(s): (Please Print) __& <br />0, AP, <br />C_ <br />Address of Property Owner(s): 2 11-2 -5 4- 4--- <br />Contractor(s) Name. <br />Contract Company Name: <br />Contractor Address: <br />/V <br />Phone: <br />Current Use of Building: Lk" <br />(Single Family -Multi-Family-Commera -Gotvrnment -Industrial - vacant - et.) <br />Type of Building Construction: ZA,7 7-414 -lam <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: [] In-kind ❑ Landscape M New A Replacement (not in•kind) [] Demolition <br />(more Than me b= may be chocked) �/ _ ;T' <br />_Z <br />Description of Proposed Work: z5_ el I 1--i 1 � ' <br />A A r - z:: - c7 Z) , 0- 4 4 - C. �ItL!61t6_ LA 21 Inq- <br />Owner/Contractor. Fax: e-mail <br />nee) <br />and or <br />APPUCA77ON RE _. UIREMENTS ARE LISTED ON REVERSE SIDE — <br />