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Application <br />- FOR - <br />Certificate of Appropilateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd, South Bend, Indiana 46601 <br />Mailing A AA- ng,South Send, T—A.ana— Arrmi <br />Drone: 574 -235 -TM * Pax 574-235.9578, # Emafl­.SBSJCHPC@costiosePhin.us <br />Website: htty://www.s"hamqindWmcx)m/s chp/ftidocltnil <br />OFFICE USE ONLY>3.>>>>DONOT COMPLETE ANY ENTRIES CONBRVEDRVII1156 BOX >>>>>>OFFICE USE ONLY <br />Date Received %5* Application Number <br />Past Reviews. afis (r)afe of Lgg Revkv) 14'4� A,!Vo a.., E]NO <br />Staff Approval authorized by. <br />Tltle:__414� <br />Historic Commission Review Date: <br />E] Local Landmark cal Historic District Ova#,) <br />National Landmark [] National Register District Ova=) <br />Certificate of Appropriateness: <br />n Denied [] Tabled E) Sent To Committee n Approved and Issued DATE <br />Address of Property for proposed work:* <br />Name of Property Owner(s): (P1=,PrW) <br />Address of Property Owner(s): <br />Contractor(s) Name: 'Q <br />Contract Company Name: <br />Contractor Address: <br />� N <br />VV r s <br />S a � .',p <br />City: , Phone: <br />Current Use of Building: .1 n cx <br />{Singh iams7y <br />Type of Building Construction: woa� 11CM,"Va <br />(jVood Frame - Brick- SIM - SW - Cmcmte - Other) <br />Proposed Work: n In-kind MLandscape [] New n Replacement (rat ink" [] Demolition <br />(mm than = is inay be d=W) <br />Description of Proposed Work: Q'( -6;%A-41WOOP <br />4- <br />ot <br />Owner/Contractor. Fax* e-mail r A <br />WcortrslxWWWJvniyrnre <br />-- APPUCA77ON REQUIRUMM ARE USM D ON <br />and/or <br />