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Application <br />- FOR - <br />Certificate of Approptiateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd, South Bend, Indiana 416601 <br />&I 1 1. Address: County -City T1 OA; South B <br />, IndianaGi)1 <br />Thorn:: 57=1-2..35-9798 * Fax: 574-135-9577 Email: SB5jClTPCtii)co.st.j().Alph.iii.tis <br />Welxiitcr littfr.//wwiv.stiowplic.ounivin(liarvi.com/,,,jclil)//in(f(?x.fitilil <br />OFFICE l.ISEONLY>>>>— DO NOT COMPLETE ANY EIVIRIESCONMINED IN THIS BOX »»» OFFICE USEOND' <br />Date Received Application Number <br />gevo - 45 <br />Past Reviews: [],YESvlf Lasl Revic-0 ...... . . . ......... . ...... . XNO <br />Staff Approval authorized by:—.- .. ......... .... . . .. . ...... Title: <br />I listoric Commission Review Date: <br />F*� Local Landinark <br />Bf0cal Historic District (.Nrame) '4i <br />Ej National Landmark [ ational Register District (.\rawr) <br />Certificate of Appropriateness: <br />Denied ❑ Tabled El Sent To Committee [pproved and Issued <br />VAIF. <br />Address of Property for proposed work: L/J�� I/ ( - — <br />'-j <br />St t IN .4cand Street Natne <br />Name of Property Owner(s): (Mcve Priw) <br />Address of Property Owner(s); 7/ L/ <br />Contractor(s) Name: P. 'fl <br />Conti -act Company Name: <br />Contractor Address: -7y0 0 14), FOld S� <br />City: Phone: <br />Current Use of Building: Y1 - <br />z - Variant etc ) <br />J <br />Type of Building Construction'.--.- <br />(Wood Frame- Rfiz* -S1w.'e- Start- Concrete - Otho) <br />Proposed Work: aln-kind R Landscape F - <br />New Replacement (not in kind) E] Demolition <br />111wre 'han oreboy du�"' <br />Description of Proposed Work; <br />-i- <br />OwnerlContr Le,, <br />,aaor: Fax: <br />... ...... . . <br />AIII)LICATION REQUIREMEMS ARF LIS -FED ON REW'.-RSE SIVE — <br />c1c,"pl <br />