Laserfiche WebLink
v` <br />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 4660] <br />Phone: 574-235-9798 o Fax: 574-235-9578 • Email: SBSJCHPCCIco.st joseplu.ii-us <br />Website: hitp://www.sgoseplicountyhidiana.com/sjchp/in.dex.lutml <br />OFFICE USE ONLY »»» DO NOT COiWPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received A0/6 Application Number <br />Past Reviews: � YES (Date o; Last Review)_ oZ� 9 ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: aTJ'roc, 01010 <br />Local Landmark ocal Historic District (.Name) 1` <br />f <br />National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />Denied ❑ Tabled E] Sent To Committee Approved and Issued <br />DATE <br />Address of Property for proposed work: 05 Z t2 la 1"A <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner(s): qC0x � ,IX0 L •• a � � ± �4 1 1 i �-�-r�� f_ <br />Contractor(s) Name: a 775 <br />d"'i? 1 4'� ► �r . <br />Contract Company Name: �P Nor". WoPeR_r/c,S <br />Contractor Address: t t <br />City: Phone: 3 <br />Current Use of Building: <br />(Single Family Multi -Family - Commercial <br />e-�Government - Industrial - vacant - etc.) <br />Type of Building Construction:1i �t✓.I��+ <br />Wood Frame - BrickStc - Steel- Conciete - Other) <br />Proposed Work: In-kind Landscape E]- New Replacement (not in-kind) [:] Demolition <br />(more thart one box nwtt be checked) <br />Description of Proposed Work:/�i` 1(.-'��,�#'�t <br />Owner/Contractor: Fax:% i' e-mail � t1-'-��� <br />(Tris r>jftn: wtll m�cslxmd uitir and y rnt esigr:ee) t • �- <br />�.���'' <br />0=dor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE - <br />