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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: County City Building, South Bend, Indiana 46602 <br />Phone: 574-235-W98 + Fax: 574-235-4578 • Email: SBSJCHPC@co.st-josep1Lin.us <br />Website: httly//wwwsqxTbcounbdncliana.com/sdip/index.htmI <br />htmi <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 02 bl-0!o Application Number?Za <br />v — <br />Past Reviews: [v_TVES (Dateof totRrriem) /9 s.?oo 4 E] NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: "t / 4�C ofd <br />Local Landmark cal Historic District (Name) <br />❑ National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />[] Denied Q Tabled [] Sent To Committee Fj Approved and Issued <br />DATE <br />Address of Property for proposed work: 9q'1' Fov-e s 4 Ave. S., G e n -A U (;:� 16 <br />Street Number and Street Naeem. <br />Name of Property Owner(s): (Phase Print) .� V tXr-' 'bo w n S C --%A 1B Y; or% <br />Address of Property Owner(s): ON, CL4-n e_ <br />Contractor(s) Name: S'_ ct^ ^ . n (Re (G r.*. <br />Contract Company Name: 9,e % 1 t ti . Lo r-% A 5 C o P e end Z) e s t `j r, <br />Contractor Address: <br />Phone: <br />Current Use of Building: <br />(Single Family - Multi -Family - Connnerrbi - Gawrnment - Industrial - Vacant - etc.) <br />Type of Building Construction:* <br />(Wood frame - Brick - Stone - Steel - Onrnte - Other) - <br />Proposed Work: n in-kind [] Landscape [] New (� Replacement (not in-kind) [] Demolition �. <br />imnr�.OtSC13(tZlttIIS�i4G1:f tY�'1, <br />Description of Proposed Work: _T�"++l <br />Pr it Araw (..1\- k6,4 <br />rD.a id 1�ict <br />e'e/it c <br />Owner/Contractor: Fax: <br />(TAa's office will mrrffpvnd with only one designee) <br />.--rip \ 0' e , A i.A Is terlk 6 (o AC>0 i- m e -1 ct 1 .� <br />e-mail <br />^�— and/or - - <br />-- APPLICATION REQUIREMENTS A RE LISTED ON RELTERSE SIDE — <br />