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It <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: Countj"-City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574235-9578 • Email: SBSJCHPC@cost joseph.in us <br />Website: http://www.sqosephcauntyindianLcom/schp/index.hW <br />OFFICE USE ONLY »»»>Di O NOT COMPLETE ANY ENTRIES CONVIINED IN THIS SOXr�»»» OFFICE USE ONLY <br />Date Received(�une "i t -U1 0 -Application Number' L 1-6 - V U() q <br />Past Reviews: [PrYES (gate of bast Review) [] NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: .21 .90/4 <br />Local Landmark oval Historic District (Name) h_Ah,.k.3 <br />❑ National Landmark ONational Register District (Name) <br />Certificate of Appropriateness: <br />Denied M Tabled E] Sent To Committee M Approved and Issued <br />DATE <br />Address of Property for proposed work: &QW4YAJ /`"_1_ <br />Sirect Number and Street Name <br />Name of Property Owner(s): (Please Pratt) Yl l v im, _ M40 YN <br />Address of Property Owner(s):( <br />Contractor(s) Name: C' L� <br />Contract Company Name: !'fir r e C tt-rt r t/r ! <br />Contractor Address: 632 -J��.�-,r_�r.,c .) <br />City: , r L ! Phone: E; 711—:VE 3 o <br />Current Use of Building: A'ZC <br />(bmagle Family —Multi-Family-kxmtmerdal — Government —Industrial — Vacant — efc.) <br />Type of Building Construction:_1*tj,c <br />( and Fr Brisk — Surae — Steel — Concrete Other) <br />Proposed Work: n In-kind [1 Landscape [ "New replacement (not in-kind) E] Demolition <br />{r:ung-#lrsratuae-�ax+mry#eefaerl�t) � �y �} ..,,/,, t � <br />Description of Proposed Work: -�� "�i1} Intf..' (bpk, � � ,L� ? 2 IGL rnIx,,,,,_.._ <br />Ro d <br />Owne ontractor. Fax: e-mailmbfimn 61 ni eL <br />o ,e will mrralvW with only one designnee) <br />/Y 7(! .. and/or - <br />— APPLICA770N REQUIRLMMS ARE LISTED ON REVERSE SIDE --- <br />