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From: <br />06/15/2010 11:40 #973 P.003/005 <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 AAA-- Catmty City Btnldmg, South Bend, Indiana 46601 <br />Phone: 574-2:i5-9798 • F=574 -ZS -95 8 • Ema1 SBSJCIPC@Co st jaseph in.us <br />Website: http://www.stjosephco m4*diumcom/sjchp/index html <br />g . 71 . <br />OFFICE USE ONLY>»»> DO NOT COMPLETE ANYENTRIES COATAUVED IN THIS BOX »»>? OFFICE USE ONLY <br />Date Received ozolG Application Number o2 O /O - Q4 I S - <br />Past Reviews: ® YES (Dau of Last xmiew) 7j, kga.4 oZd I& <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />Local Landmark E 'focal Historic District (Name) <br />Ej National Landmark ❑ National Register District pvame) <br />Certificate of Appropriateness: AA <br />Denied [] Tabled ❑ Sent To Committee 0 Approved and Issued 0/6) <br />U Dazs <br />Address of Property for proposed work Ujau,110. f:=& ) <br />Stmt Number d Sheet Name _ <br />Name of Property Owner(s): (.Please Print) ro 1 - --t>,o n rNq <br />Address of Property Owner(s): <br />Contractor(s) Name:�(- 1 n 1 bLt <br />Contract Company Name: <br />Contractor Address: <br />City �ja 11 9n Ka Phone,52q `&CZ' <br />Current Use of Building: , <br />�t'�v� t I" <br />(Single Family — Multi F=4 — CommereW — Government — Industrial — Va=a — etc.) <br />Type of Building Construction: <br />(woad Frame -Brick -Stone - Steel- Conente- Other) <br />Proposed Work 56In-kind[] Landscape 0 New XReplacement (not in-kind) ❑ Demolition <br />(more than one box may be . <br />Description of Proposed Work C 1 n� <br />�r- <br />Owner/Contractor. F=L- e-mail_ 0-6 unn %5dV,-4v- .0pha1 fl <br />(This office will correspond with only one designee) J <br />and/or <br />— APPL =01V REQLIIREMENNTS ARE LIS= ONREVERSE SIDE -- <br />