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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: SBSjCHPCOco.st josephinus <br />Website: http / /wwwsgosephmuntyindiana.com /s chp /indexhtml <br />OFFICE USE ONLY >>> >>> DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX » »» OFFICE USE ONLY - <br />Date Received _&A-11 aD /u Application Number 2 0 - 0 <br />Past Reviews: 03 (vate Of Lot itakw) / 1 f a -" 6 E] NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: 1 ow /d <br />n Local Landmark Blocal Historic District (Name) <br />E] National Landmark (t. tational Register District (Name) ? ".�c� Ya4-�– <br />Certificate of Appropriateness: <br />Denied []Tabled E] Sent To Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work: 9 44 f�tiV AM " r j%t o <br />Street Number and Street Name <br />Name of Property Owner(s) (Please Print) )AV , Z1 'ger.0 3 .1 J ILt NI F et? W Af2LtCIL <br />Address of Property Owner(s): iX 4 et VQ. t �r. <br />Contractor(s) Name: R �,{C Scc'+4 4 <OAAS. I QG , <br />Contract Company Name: V c___ <br />Contractor Address: end V10�,cc%�.�! <br />City: 4 G;619 Phone: 5'7q .Z 9 / – 7 7tp 6 <br />Current Use of Building: S�^q -�- �• <br />(Single Family — Multi- ily — Commercial —Government —Industrial — Vacant— etc.) <br />Type of Building Construction: wood FRww. o <br />(Wood Frame — Bridc — Stone — Steel — Concrete — Other) <br />Proposed Work: ❑ In -kind ❑ Landscape ❑ New © Replacement (not in -kind) ❑ Demolition <br />(more than one box may be dunked) <br />Description of Pro osed Work: Raw&o MM – &2% <br />.t%% 2 jk00r YA�h .Q., ^' - ��,,ac l+or OA- 4.4, <br />/t2 A. i Cv� OAI& C <br />Jl2 X31 {t <br />t . <br />Owner /Contractor. Fax: e-mail <br />(This i DTI correspond will yon nee) — <br />and /or <br />ISI ED ON REVERSE SIDE — <br />