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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. 1-afayette Blvd., South Bend, Indiana 46601 <br />Mallit2g Address: County CityBuilding South BendIndiana 46b01 <br />Phone: 574-2,35-9-798 - Fax:574-235-9578 - Etnafl:SBSJCHPCI,Pco,st-josepli,in.us <br />Website: http://wwiv.sqosephcountyindiana.com/sjchp/index.htnil <br />OFFICE USE ONLY »»» DO NOT COMPLETE <br />AW ENTRIES COINTIEVEDINTPIIS BOX """OFFICE USE O4VI'Y <br />Date Received Application Number °20 0 70,2, <br />Past Reviews: [RrVES(Darr ofLa.,tRezi,-,,) <br />Staff Approval authorized by: <br />Historic Commission Review Date: '/ � A-41 OW/ 0 <br />F� Local Landinark [2 -Local Historic District (,Vwtie) <br />F-1 National Landmark E] National Register District <br />am <br />Title: <br />Certificate of Appropriateness: <br />E] Denied F� Tabled n Sent To Committee n Approved and Issued <br />DATE <br />3 ?_ 2- t�Gu A <br />Address of Property for proposed work: 1tl <br />Strect NumHcr and Street ,Name. <br />Name of Property Owner(s): (Please Print) T. A/4 6 &Vi 4- <br />....... .. .... ..... ...... <br />Address of Property Owner(s): <br />Contractor(s) Name: -P'4-V1 D i� U P_ T) <br />Contract Company Name: L F n J 7- A LJ S i t ri i-1 <br />Contractor Address: 1` 0 A- D <br />City. P C b t? iV phone: _S­71-,­"7°r°3­(-,ei5`7 <br />Current Use of Building: <br />{tingle Family --k-fidl-Famity — CotntrerrW — Got-crivnert — [ndusirial — Vacant — etc.) <br />Type. of Building Construction: -13,P, ( CK / '5 7- L)c c<� T'(? <br />("7wd Franic — Brifk — Shme — Steel — Concrete — Other) <br />Proposed Work: In-kind r-1 Landscape New (j Replacement (not in-kind) Ej Demolition <br />6now jjWn or"a IVx <br />Description of Proposed Work: Ze 14, e � <br />r <br />Owner/Contractor: Fax: e-mail <br />........ . . -___-and /or . . . . ... ..... . . ............. ....... . . ...... <br />APPLICATION REQUIREJNIENTS ARE LISTED ON REIERSE SIDE — <br />