Laserfiche WebLink
Application <br />- FOR - <br />Certi <br />fiCate of Appropriateness <br />Historic Preservation Conunission of South Bend & St Joseph County <br />125. S. Lafayette Blvd., South Bend, Indiana 46601 <br />1VAa414"n AAA—s- County-CityBuilding, South Bend, T"AinnnAAM1 <br />Phoney 574-235-9798 * Fax: 574-05-%78 * Email- SBSjCHPC&o.st-jo5Y_T1Linus <br />Websita httly//www.stjosephcounVindiana.com/Ichp/indey-litniI <br />OFFICE USE ONLY>>>>>> DO NOT COMPLETE ANYENWES CONTAIN ED IN 77HS BOX >>>>>> OFFICE USE ONLY <br />Date Received '44ze4t,"a,OJD Application Number A4'/ a - 0.Z66 <br />Past Reviews: 21ES(Mtoflast Review) E) NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />Local Landmark B't6cal Historic District (Name) <br />National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />F1 Denied E] Ubled Sent To Committee DApproved and Issued <br />DATE <br />Address of Property for proposed work: 'Rtfl 'rbre-w Aj(-C)(Afz 'S13W qWz kL- <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) 00 it D( -) k t -) r1-";: <br />Address of Property Owner(s): tAq Ot tJ 4L- G 16 <br />Contractor(s) Name: w n o r t. w, C4. <br />Contract Company Name: A -A e- 1l % *i-\, % Lek nA<.rn in <br />.J90 C ItV c- I On -A <br />Contractor Address: 1! <br />q -4- <br />City. q Phone: /qV Z_ <br />Current Use of Building: xi tA e, to, rr'rv)."x <br />d <br />(Single wti.,Family - Commercial - Covernmew - Industrial - Vacant - etc.) <br />Type of Building Construction: <br />(Wood Frame - Bra - Stone - Steel - Concrete - Other) <br />Proposed Work: XIn-kind RfLandscape nNew 0 -Replacement (not in-kind) nDemolition <br />(more than one box may be checked) <br />Description of Proposed Work: _T wowA live 4o t'v% a V c k- k e ex isA*;A5 <br />0 ctA n _q e 4-1s e (A 1 .4 Lj <br />Owmer/Contractor. Fax: e-mail <br />(M. rfa tar, cmeTand with only Otte desigree) <br />--> and/or- ...... <br />APPUC41YON REQLURFAIENTSARE LISTED ON REVERSE SIDE -- <br />