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OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX » »» OFFICE USE ONLY <br />oil <br />Date Received Application Number <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: 574235 -97'98 - Fax 574 - 235-578 - E=l: SMjCHPC®co.st josephinus <br />Website: http: / /www.sgowphc mmgindiana.com /sjchp /indexhtn l <br />Past Reviews: [+ YES (aateoft tML..) <br />Staff Approval authorized by: <br />Application <br />- FOR - <br />/G ?X4"Z ,2 0 9 E] NO <br />Historic Commission Review Date: /lo <br />Title: <br />.2UID <br />F1 Local Landmark ® Local Historic District (Name) <br />❑ National Landmark n National Register District Waste) <br />Certificate of Appropriateness: <br />Le.,� <br />Denied n Tabled [] Sent To Committee Fj Approved and Issued <br />DATE <br />Address of Property for proposed work: - ` �ll rI <br />Stmt Number nd S me <br />Name of Property Owner(s): (Phase Print) � et� t .�Z�' <br />Address of Property Owner(s). 5 C7, C rk ( n A � <br />Contractor(s) Name: � � t. TAQ NA k_ * 1 <br />Contract Company Name: <br />Contractor Address: C (1j <br />City: M � Phone: <br />� <br />Current Use of Building: �. Y) _ �_ �Frk/clr\ \ d � - <br />(Single Fami6multi Family - Commercial - Government - Ind ¢ .Sl - Vacant <br />Description of Prop ed Work: _ A, M A .0 L_ I �� ) <br />Owner /Contractor. Fax: <br />(This r toith only one designee) - <br />x a/ 1 and /or <br />Type of Building Construction: <br />(Wood Frame —Brick —Stone —Steel — Concrete — Other) <br />Proposed Work: ❑ In -kind ❑ Landscape ❑ New Peplacement (not in -kind) ❑ Demolition <br />(more than one box may be dw& d) <br />— APPLICATION REQ UIREMENTS ARE LISTED ON REVERSE SIDE — <br />G ^rjI <br />