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Application <br />- FOR - <br />Certif icate of Ap roptiateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette BIvd., South Bead, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phones 574235-9798 , Far 574735-9578 • Email: SBSJCHPC@w st jowls uaus <br />Website: http://www*%Thamntyh dkmtom/Ichp/indexlitml <br />OFFICE tISE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONPLINED IN THIS BOX »»» OFFICE i1SE ONLY <br />Date Received �G' ` ' oM /O Application Number <br />Past Reviews: B YES (nate,jL t Rr�) t 0? 5 [] NO <br />Staff Approval authorized by: Title: <br />Historic Comrnlssion Review Date: J <br />[] Local Landmark Q'Lacal Historic District Qvame) <br />National Landmark Ca' ational Register District Come) <br />Certificate of Appropriateness: <br />[) Denied F1 Tabled [] Sent To Committee Approved and issued <br />DATE <br />Address of Property for proposed work: (6 12- I'c'r +Q St A% t n a r- s- v +t, -Azu t et eJ t Al Y (v G 1 to <br />Street Numbrrand Shut Name <br />Name of Property Owner(s): (Fime print) C- hop % r`+ P ex.r+t<. '= n e _ 1 c� to n 'LNOr ,...s rss • %'+r o a 4 e rn k o , <br />Address of Property Owner(s): iso et 'Fu r r a i A v g. s S t N M t., to tI.- pres % d e t%+ <br />Contractor(s) Name: t !K i c .410 r r, i #% *r i ~tag %n.t 0,% h e r. 7-9 <br />Contract Company Name: W tx ♦ K el ",N 1 N 4 65 I'-1 ca � Lf - 2 3 2 ttffi <br />Contractor Address: r +o o{x-r : Rr ad 'tom %e rs on q-+ fn'R �?cac;s�i tzs�d Rr�rsd <br />city: M S'V• Ct ..% exY ra t 10 ti (.4-,44 4 S`4 `t -4 11 - Phone � 4 <br />Current Use of Building: t n �o t c .�` r� k�� <br />l .,r...• <br />iSingk Family -Multi -Family- Commercial - Comrnmmi - lndsaxtrial - Vacant - et ) <br />Type of Building Construction: w o o•A -� r 0 '.n C <br />(Wood Frame - Brick - Ston - Steri - Concrete - Other) <br />Proposed Work: D;pn-kind [] Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more Man one b= amy be dwdW <br />Description of Proposed Work: l61 s'N: nQ 0 hey r e s_.�...1 i ci 44,e <br />:h Iq t- ntr-A pn-Ahe <br />Or I utsP...) ne�.&A trP0.1, i., K��d Q11 e+x-Jcr�or <br />4-1.% ret . i, r X %A A .*n q A -,r 1 r"% Q&CLiLr►d <br />n. <br />Owner/Contractor: Fax: w. t+ A , \ole -man <br />(This of= wM currapond with only onednignu) <br />OL .+ % anti/or <br />— APPUCA71ON REQIHRB40M ARE LISTED. ON M ERSE SIDE -- <br />