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Application <br />- FOR - <br />Certi f icate 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 46601 <br />Phone: 574235-9798 - Fac 574235-957$ - Email: SBSJCHPC®cost josephin.us <br />Website:htty://www.sqoseph=mVW=iLc=/Ochp/mdec.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received -316. I�• I -D Application Number 0 10 - 0 b 1 q <br />Past Reviews: ❑ YES (Dole of Last xwkw) ' <br />Staff Approval authorized by-. <br />c• <br />Title: <br />Historic Commission Review Date: <br />Local Landmark tt Local Historic District (Name) 1 �► r�1�� y �r� �� <br />National Landmark 0 National Register District Ova=) <br />Certificate of Appropriateness: <br />Denied [! Tabled [] Sent To Committee B A' pproved and Issued <br />DATE <br />Address of Property for proposed work: 86.3 PSN L AN D <br />//}} /� Stmt Number and Stmt Name <br />Name of Property Owner(s): (Please Print) 0 N R) s t ' 140 cl L t -T <br />Address of Property Owner(s): 8 0 :� <br />Contractor(s) Name: r-*! ' N 40 C. le- i t� <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Phone: S71 9 " 2-6 1- S 18 % . <br />Current Use of Building 1SI nE%tA F*M t L <br />(Single fandly-Mutts-Family - Conmercial - CrUMMMent - znriustriat - vaamt -etc ) <br />Type of Building Construction: W u o o. F RAcn <br />(wand FM= - Brick - Stone - Sheet - Concrete - Othrr) <br />Proposed Work: 14 In-kind Landscape [] New Replacement (not in4dn4 ❑ Demolition <br />(wre than one baa maybe d=W) <br />Description of Proposed Work: fl 14 TE t4 A C- C q 12 S E z <br />Owner/ on ctor: Fax: e-mail <br />(This orae with only one designee) <br />and/or <br />APPLIC47TON REQUiRIalVTTF.NIS ARE LISTED ON REVERSE SIDE -- <br />