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0 <br />Application <br />-FOR- <br />Certificate of Appropriateiress <br />Historic Preservation Commission of South Bend & St. Joseph County <br />123 S. Lafayette Blvd., South BLmd, Indiana 4(a)1 <br />Mailing Address; County -City Building, Sou4,11 A Indiana 4&Ml <br />Phone: 57.42,35-9798 • Fax: 574-2.35-�78 * Email: SBSJCHPC@co.st-joscphin.us <br />Website: littp://w%8,w.sgosephcotintyindiafui.com/sjchp/indc!x.htnil <br />OFFICE USE ONLY»»» UO NOT COMPLETE ANY ENTRIES COIVIAINED IN THIS BOX >>>>>> OFFICE USE ONLY <br />Date Received 7" of 0/0 Application Number cl b % 0 _ 06'd 7 <br />Past Revlinvs: BYES (Dhte ofU.,f Ree. mut /7 A�c� t td [j NO <br />Staff Approval authorized by: t -/1.fix Title: ..t�.lt,&4, <br />Historic Commission Review Date: <br />[-1 Local Landmark P'Local Historic District (..N'ame) C_t_A ' <br />R National Landmark �ational Register District (Nanta) <br />Certificate of Appropriateness: <br />❑ denied ❑ Tabled [] Sent To Committee [ pproved and Issued 7 <br />DATE <br />Address of Property for proposed work: ZY y=' <br />Name of Property Owner(s): (Please Print) _.._`_` / J' %; <br />Address of Property Owner(s): <br />Contractors) Name: <br />Contract Company Name: <br />Contractor Address: <br />City: <br />r- <br />Street Number an.i Street Name <br />X/1 <br />Phone: :, ' x '- `l' 10 7 _,;� <br />Current Use of Building: i N <br />(Single. family — Multi -I amily — Commercial — Ccn.t=ernmrnt — Industrial — Vamnt — etc.) <br />Type of Building Construction: <br />(Wood Frame— Stink — Slone— Steel — Concrete — Other) <br />nruposed.Work• gln kind __[] Landscape _._.0 Newt/ _E]Yepl4cenient (not in-kind) FI Demolition <br />(mare than one brat tray be choked) <br />Description of Proposed Work-, <br />£ "i' C.. l l fr`_< f' ' y Q %G „ .K" 1 ' i'.✓ 4 - <br />f/.,.fAj j P .tf` /< r t...� k ` 't.. ) �. � i'....FF, . !,'•, ,,,,, � y r - ,� % P�' '', .,� '/-..... <br />Owner/Contractor, Fax: e-mail <br />_ (This ojfix urT� rturrtjxx3d tufth or� one ds�igr:c�t} <br />and/or __...._..__._.__�_._._. _____..._..__...._ __....... _.._. <br />— APPLICATION REQUIRE.&IENTS ARE LISI1D ON REVERSE SIDE, -- <br />